Mastitis

Abstract

Inflammatory conditions of the breast are uncommon and may be encountered in the puerperal and nonpuerperal setting. Mastitis, in the postpartum period, is identified by a localized wedge-shaped area of erythema and tenderness on examination of the breast. It is usually caused by staphylococci and should be treated with oral antibiotics and continued breastfeeding. Early treatment decreases the risk of abscess formation. Lactational abscesses may be difficult to diagnose if a distinct fluctuant mass is not present on examination, but ultrasound can be helpful in identifying a fluid or pus collection. Although conventional incision and drainage is most frequently used to treat abscesses, ultrasound-guided aspiration or catheter placement may be attempted as alternative treatment approaches. Nonpuerperal mastitis is less common and usually presents with inflammation and chronic abscess formation in the areolar region. This condition is most commonly a result of squamous metaplasia of the duct system leading to obstruction and subsequent abscess formation. These abscesses often drain spontaneously and may develop skin fistulae. Treatment, therefore, requires excision of the involved duct system with careful reconstruction of the nipple. Mastitis may also result from uncommon infections such as tuberculosis, Corynebacterium striatum, and Pseudomonas aeruginosa. Additionally, noninfectious conditions, such as lymphoma and carcinoma, may be diagnosed in a patient presenting with breast tenderness and erythema. Hopefully, increased awareness of the possible causes of breast inflammation will lead to early and more effective treatment.