Lactational Breast Research Articles

Bacteriological profile and antimicrobial susceptibility pattern of non-lactational breast abscess

BACKGROUND: Breast abscess is a common condition among OPD female patients. It has been reported that 4.6 % and 11% of the women in developed and developing countries are affected by breast abscess. AIMS AND OBJECTIVES: To detect the pathogens causing non lactational breast abscess and to determine their antibiotic sensitivity pattern. MATERIALS AND METHODS: 50 pus samples with diagnosis of non lactational breast abscess were obtained by incision and drainage or by aspiration. Specimens were processed for Gram stain and cultured in both aerobic and anaerobic media. For aerobic blood agar (BA) and Mac-Conkey agar were inoculated. For anaerobic isolation Brucella blood agar (BBA) with 5% sheep blood agar, hemin and vit-k were inoculated and Metronidazole disc was placed in primary streaking line. Plates were incubated in Mark-II Anaerobic system. Isolates were identified by Gram stain, biochemical tests and sensitivities to identification discs like Vancomycin, Kanamycin, Colistin and SPS. Sensitivity patterns of the aerobic isolates were determined by Kirby-Bauer disc diffusion method. RESULTS: Maximum no of cases belongs to age group of 36-45 years (42%). Out of the 50 pus samples 36(72%) were found to be culture positive from which 42 number of bacteria were isolated. Aerobes and facultative anaerobes predominated 30(71%) over the anaerobes 12 (29%). Staphylococcus aureus 11(36%) was found to be the predominant organism. Clostridium perfringens 6(50%) was the commonest anaerobe isolated. Gram positive isolates were sensitive to Clindamycin, Linezolid and Vancomycin and gram negative bacteria were sensitive to Imipenem and Piperacillin-Tazobactam. Percentage of MRSA was 43% .Amongst the gram negative bacteria ESBL production was seen in 55% of isolates. CONCLUSION: Breast abscess is a fairly common surgical problem among both lactational and non-lactational females. Besides aerobes non-lactating breast abscesses also showed the presence of anaerobic bacteria. As minimally invasive management of breast abscesses, such as ultrasound guided drainage with systemic antibiotic drug therapy is the treatment of choice it is essential to provide the appropriate empirical antibiotic therapy in this drug resistance era.

Management challenges of complicated lactational breast abscess in a tertiary health facility in a resource-constrained environment

Background: Lactational breast abscess, if not promptly and appropriately treated, can become complicated with associated destruction of breast skin and tissue that may necessitate breast resurfacing or reconstruction. The study is aimed at highlighting management challenges of patients who presented with complicated lactational breast abscess to a tertiary health facility in a resource-constrained environment. Patients and Method: A retrospective review of patients who presented with complicated lactational breast abscess to a tertiary health facility in northwest Nigeria from April 2015 to March 2017 was carried out. Patients were identified using the hospital admission records and appropriate data were retrieved from their case notes and analyzed. Results: A total of 17 patients were included in the study and 10 (58.8%) were in the age range 21 to 30 years. Nine (52.9%) patients presented in the puerperal period and 10 (58.8%) patients were multiparous. Left breast was predominantly affected accounting for 10 (58.8%) cases whereas there was bilateral breast involvement in four (23.5%) patients. Sixteen (94.1%) patients presented after the symptoms have started for more than a week. Four (23.5%) of the patients had necrotizing infection. Six (35.3%) patients had surgical intervention for breast resurfacing or breast reconstruction whereas 11 (64.7%) patients declined surgery due to financial constraint. Conclusion: Complicated breast abscess is not uncommon among lactating women in our environment due to late presentation resulting from illiteracy, poverty, and cultural practice of seeking alternative medical practice and its management is challenging to the surgeon partly due to financial constraint for patients’ treatment.

Lactational Breast Abcess : A Cross Sectional Evaluation of Features and Clinical Interventions

This is a cross sectional study of 50 cases of breast abscess admitted to Dhaka Medical College Hospital. The aim of this study is to find out the pattern of clinical presentation, microbiological study, and treatment modality. To find out the aetiological factors detailed history was taken. Married woman are the major victims of the barest abscess (98% of the study). Women who had home delivery and suffered from puerperal sepsis are more vulnerable. Poor; malnourished, rural women are major victims. Due to lack of health education it prevails mainly in the illiterate women. Coexisting other infection (U77, skin infection etc.) acts as risk factor (50% of the study had other infections). Regarding clinical pattern most of the patient presented with painful swelling in the breast with rednessS. induration with or without fluctuation. A small number presents with spontaneous bursting (8%) and discharging sinus (7%). Regional lymph node involvement was not significant, A significant number of nipples were found cracked (35%of the study).Reganling bacteriological study Staphylococcus aureus was the major organism to be isolated(76%of the study) which showed it sensitivity to Flucloxacillin most In 5 suspected cases biopsy was taken from abscess cavity of which 1 revealed as tubreculous infection.All of the cases were drained under GM. All of the cases were treated post operatively by antibiotics & dressing except 1 case which needed anti tubercular chemotherapy. Only 4 cases needed secondary closure due to delayed healing.

A Prospective Comparative Study of Needle Aspiration vs Incision and Drainage of Lactational Breast Abscess

A Prospective Comparative Study of Needle Aspiration vs Incision and Drainage of Lactational Breast Abscess

PO10 Management outcomes in lactational breast abscesses: 10-year tertiary centre review

Background & purpose: Lactational breast abscesses are a serious complication of mastitis which may lead to hospitalisation. Literature examining the incidence, risk factors and optimal management is limited. The purpose of our study was to evaluate patient characteristics and management of lactational breast abscesses in order to inform women about this benign breast disease.

Surgery without knife: an ideal treatment for lactational breast abscess

Background: Incidence of breast abscess is 0.4 to 11% of all lactating mothers. Traditionally the treatment of breast abscess has been incision and drainage. Recently aspiration under ultrasound guidance is emerging as another treatment option and rapidly replace incision and drainageMethods: Authors carried out a prospective, randomized study involving 50 lactating women with breast abscess. In group A - 25 patients were managed by ultrasound guided needle aspiration and in group B - 25 patients were managed by incision and drainage.Results: In patients of group A, most breast abscesses resolved with one or two aspirations only, with early healing and lesser number of hospital visits as compared to patients in group B. There was no surgical scar and early resumption of breastfeeding was seen in group A.Conclusions: Ultrasound guided percutaneous aspiration is an effective modality of treatment of lactational breast abscess and it should be the first line of treatment, especially for smaller and unilocular breast abscesses while incision and drainage should be reserved for larger and multilocular abscesses with imminent skin changes.

Analysis of the microbial flora in breast abscess: a retrospective cohort study conducted in the emergency department

Background: Breast abscess develops as a complication of lactational mastitis. Recently, there is an increase in the incidence of non-lactational breast abscess. The aim of the study was to analyse the microbial flora in the lactational and non-lactational breast abscess in the ED and to elucidate the susceptibility of flora to different antibiotics.Methods: This is a retrospective cohort study of breast abscess patients registered in the ED over two years. The case records of these patients were retrieved, and the details of their age, clinical presentation, investigation, and treatment were recorded. Specifically, the pus culture sensitivity and antibiotics used in the management of these patients were noted, and the pattern of microbiological flora analyzed.Results: A total of 124 patients were included in the study, with 97 women were categorized into lactational breast abscess, and 27 women were classified as a non-lactational breast abscess. Mean age was 24 years of age (Range 18 to 56 years). The majority of the women were young between 18 and 34 years of age (83%). The culture was grown in 92% of the patient pus specimens. Staphylococcus aureus (83%) was common organisms cultured in lactational breast abscess. Mixed Flora including Staphylococcus aureus and Group B Streptococci were grown in non-lactational breast abscess.Conclusions: Appropriate antibiotic choices are of immense importance in the management of breast abscess. Mixed flora is common in non - lactational breast abscess when compared with a lactational breast abscess. Staphylococcus Aureus is the most common isolate in both groups.

Effect of the Affordable Care Act on Disparities in Breastfeeding: The Case of Maine.

To evaluate the Affordable Care Act (ACA) breastfeeding provision and test whether changes in coverage affected women differently according to health insurance status. We used the All-Payer Claims Database from Maine (2012-2014) to compare health insurance claims for lactation classes and breast pumps between women with private insurance and women with Medicaid (1) before the ACA breastfeeding provision, (2) after the provision came into effect, and (3) after health insurance expansion through the Marketplace. We found limited change in claims for lactation classes over the study period. By contrast, the number of claims for breast pumps among women with private insurance increased from 70 claims in the third quarter of 2012 to 629 claims 1 year later and 803 claims in the third quarter of 2014. Women with Medicaid had only 11 claims for breast pumps over the entire study period. This 11-fold rise in claims for breast pumps by women with private insurance suggests that these women will likely increase breastfeeding initiation or duration; however, without additional support for women with Medicaid, disparities in breastfeeding may increase.

Diagnosis of non lactation mastitis, breast cancer by color doppler flow imaging and ultrasonic elastography

Objective To study ultrasonic parameters characteristics of lactation mastitis, breast cancer by using color doppler flow imaging(CDFI) and ultrasonic elastography(UE), and to explore its clinical value. Methods Retrospective analysis was conducted in the clinical data of 85 female patients(a total of 85 breast lesions). All patients were confirmed by pathology, and according to the results of pathology, they were divided into non lactation mastitis group(group NLM, a total of 28 cases), breast cancer group(group Ca, a total of 57 cases). All patients accepted CDFI and UE before treatment, and compared ultrasound parameters between the two groups. Results The proportions of class 0~I(71.43%) and RI<0.7(82.14%) in group NLM were significantly higher than those in group Ca, while the proportions of classⅡ~Ⅲ(28.57%) and RI≥0.7(17.86%) were significantly lower than 75.44%, 84.21% in group Ca(χ2=17.185, 35.217, all P<0.05). The UE ratings(1.75±0.97) and the strain rate ratio (1.64±0.83) in NLM group were lower than (4.19±0.74), (5.03±1.08) in group Ca(t=-12.873, -14.623, all P<0.05). The accuracy of CDFI + UE(89.41%) was higher than the accuracy of UE(76.47%) or the accuracy of CDFI(67.06%)(χ2=12.337, P<0.05). Conclusion CDFI, UE have a certain diagnosis ability for non lactation mastitis and breast cancer, combining both can obtain better diagnostic value, which is worthy of clinical application. Key words: Ultrasonography, doppler, color; Elasticity imaging techniques; Mastitis; Breast neoplasms

Negative Suction Drain Through a Mini Periareolar Incision for the Treatment of Lactational Breast Abscess Shortens Hospital Stay and Increases Breastfeeding Rates

Although breast abscess is a serious uncommon complication of mastitis with high morbidity rate, there is a lack of high-quality randomized trial to demonstrate the best treatments. We reported a novel way of applying negative suction drain through a mini periareolar incision. We retrospectively analyzed and compared the clinical characteristics of 62 patients with lactational breast abscess in our department from August 2012 to April 2015. Thirty-two patients went through traditional incision and drainage (Group A) and 30 patients were placed on negative suction drain through mini periareolar incision (Group B). There is no significant difference between the two groups in terms of age, white blood cell (WBC) count, size of the abscess cavity, and positive rate of Staphylococcus aureus (SA) or methicillin-resistant Staphylococcus aureus (MRSA). Patients in Group B had a shorter hospitalized stay (p = 0.003) and had a higher rate of continuation of breastfeeding (p < 0.005). Applying drain with negative suction pressure through a mini periareolar incision is an effective modality for treating lactational breast abscess and maintaining breastfeeding.

Lactational breast changes/lobular hyperplasia mimicking masses: how can we differentiate from true pathological masses?

Objective The aim of this study was to evaluate the role of sonomammography in the characterization of clinically palpable breast masses during pregnancy and lactation with differentiation of true and false (lobular hyperplasia/lactational changes) masses. Materials and methods One hundred patients with clinically palpable breast masses during pregnancy and lactation were evaluated by means of ultrasound (US). Mammography was performed only for 23 patients. Mammographic and sonographic findings were evaluated retrospectively. When US or mammography revealed a benign lesion, no further diagnostic evaluation was necessary. However, when US or mammography demonstrated a suspicious lesion, biopsy was performed. Results US showed lobular hyperplasia/lactational breast changes categorized as Breast Imaging-Reporting and Data System 2 (BI-RADS 2) in 13 cases, a lesion with the criteria of benignity categorized as BI-RADS 2 in four cases, BI-RADS 3 in 68 cases, BI-RADS 4 in three cases, and BI-RADS 5 in 12 cases. Mammography showed normal dense breast categorized as BI-RADS 1 in four cases, lesions with criteria of benignity categorized as BI-RADS 3 in six cases, BI-RADS 4 in two cases, and BI-RADS 5 in 11 cases. Trucut biopsy established the pathological diagnosis in 22 cases. Conclusion Most of the pregnancy-associated breast masses are benign. Nevertheless, a strict assessment of any lesion is required, to exclude malignancy and to rule out lactational breast changes/lobular hyperplasia that may present as lump. US is the most appropriate radiologic method for evaluating breast disorders in women during pregnancy and lactation.

Lactational breast changes/lobular hyperplasia mimicking masses: how can we differentiate from true pathological masses?

Lactational breast changes/lobular hyperplasia mimicking masses: how can we differentiate from true pathological masses?

Lactation Support and Breast Milk Management

The past 20 years have seen dramatic growth of hospital lactation programs. There are few regulatory guidelines leaving advocates for lactation services to justify need, safety, and best practice to implement changes. The professional networking group, Children’s Hospital Lactation Network, was surveyed about breast milk facilities and practices. Analysis of survey responses will provide lactation programs with information needed to identify improvements and recognize priorities for lactation practice and safe, effective breast milk management. Lactation programs need specific regulations to guide practice to enable them to receive funding for equipment and staffing and support to make decisions on policies and best practices. Specific recommendations, consistent between regulatory agencies and across the United States, would be beneficial to optimizing lactation support for hospitalized infants and their families.

Comparison of needle aspiration and vacuum-assisted biopsy in the ultrasound-guided drainage of lactational breast abscesses.

Purpose:The purpose of this study was to compare needle aspiration and vacuum-assistedbiopsy in the ultrasound-guided treatment of lactational breast abscesses.Methods:Between January 2005 and December 2014, a total of 74 patients presented withlactational breast abscesses. Thirty of these patients underwent treatment with antibioticsalone, while the remaining 44 lactating women with breast abscesses were treated withneedle aspiration (n=25) or vacuum-assisted biopsy (n=19). Age, duration of lactation, abscess diameter, pus culture results, the number of interventions, the healing time, and the cure rate were reviewed and compared between these two groups. The Student’s t test and the chi-square test were used to compare the variables.Results:No significant difference was found in the cure rate between the needle aspirationgroup (22/25, 88%) and the vacuum-assisted biopsy group (18/19, 94.7%) (P=0.441). However, the mean healing time was significantly shorter in the vacuum-assisted biopsy group (6.7 days) than in the needle aspiration group (9.0 days) (P=0.001).Conclusion:Vacuum-assisted biopsy is a viable option for the management of lactational breast abscesses and was found to lead to a shorter healing time than needle aspiration. However, further study is necessary to establish the clinical efficacy of vacuum-assisted biopsy in the management of lactational breast abscesses.

Treatments for breast abscesses in breastfeeding women.

CITATION: Irusen, P. H. et al. 2015. Treatments for breast abscesses in breastfeeding women. Cochrane Database for Systematic Reviews, 8: Art. No.: CD010490, doi:10.1002/14651858.CD010490.pub2.

Abcès du sein lactant : et si on ne les opérait plus ?

To show the effectiveness of ultrasound-guided puncture in the treatment of lactational breast abscess and identify its risk factors.Retrospective descriptive study at the CHU of Lyon-Sud from December 2007 to December 2013, including patients with lactational breast abscess confirmed on ultrasound and treated with antibiotics and analgesics. Realisation of ultrasound-guided needle under local anesthesia by the radiologist and washing the cavity with physiological serum.Forty patients had lactational abscesses at an average of 10 weeks post-partum. Thirty-four patients were treated by needle aspiration, of which 2 had first surgical drainage. The average size of the abscess was 41.2mm. The success rate of needle aspiration was 91.2%. No cases of recurrence were observed, however, there were 5 fistulisations. In all, 91.2% were treated on an outpatient basis. In 87.8% of cases, breastfeeding was continued on the healthy side and in 48.5% of cases on the affected side. The major risk factor for abscess was mastitis in 91.1% of cases.Ultrasound guidance of needle aspiration should be gold standard for the treatment of lactational breast abscesses to continue breastfeeding including the affected side.

Asynchronous milk ejection in human lactating breast: case series.

Milk production is under the influence of autocrine control such that the rate of milk synthesis decreases as the breast fills with milk. Effective elimination of milk from the alveoli via the milk ejection reflex will therefore result in increased milk synthesis. It has been assumed that milk ejection occurs in all alveoli simultaneously; however, animal studies have indicated that full alveoli eject milk sooner than less full alveoli, suggesting heterogeneous emptying of the mammary gland. The aim of this study was to determine whether milk ejection occurs asynchronously in the human lactating breast. Retrospective analysis of videos made of ultrasound monitoring of milk ducts during pumping. Six video clips (4 women) of ultrasound monitored milk ejections showed obvious differences in the timing of milk flow between different main milk ducts. Duct diameter was simultaneously measured every second in 2 different ducts that drained 2 separate lobes of the breast. For 5 of 6 ultrasound duct monitoring sessions, both duct dilation and visualization of milk flow in the 2 separate main milk ducts differed by 2 to 8 seconds. For the remaining woman, milk was observed to eject from 1 part of the lobe, and when not removed, it flowed in a retrograde fashion into a different part of the lobe. Asynchrony of milk ejection occurs in the human lactating breast, suggesting that the timing of myoepithelial cell response differs, resulting in heterogeneous emptying of the gland.

Modeling of milk flow in mammary ducts in lactating human female breast.

A transient laminar Newtonian three-dimensional CFD simulation has been studied for milk flow in a phantom model of the 6-generations human lactating breast branching system. Milk is extracted by the cyclic pattern of suction from the alveoli through the duct and to the nipple. The real negative (suction) pressure data are applied as an outlet boundary condition in nipple. In this study, the commercial CFD code (Fluent Inc., 2004) is employed for the numerical solution of the milk flow. The milk intake flow rate from simulation is compared to the real clinical data from published paper. The results are in good agreement. It is believed that the methodology of the lactating human breast branching modeling proposed here can provide potential guidelines for further clinical and research application.

Mammary cells synthesize insulin during lactation (622.3)

The mammary gland undergoes extensive remodeling during pregnancy and lactation to mature into a milk‐secretory organ. This remodeling is accompanied by a series of alterations in gene expression that are fuelled by hormonal changes facilitating maturation of epithelial cells. Insulin, supplied by the maternal circulation, is thought to play a key role in this process. In this study, we examined whether mammary cells endogenously synthesize insulin during lactation. First, we stained rare specimens of human lactating breast tissue for insulin and found that some, but not all, mammary epithelial cells were positive for insulin. We subsequently confirmed this finding with FACS. We then detected the transcript for insulin in mammary cells accessed via freshly expressed breastmilk. Transcript levels were highly variable among the breastmilk samples tested, and were significantly higher than in mammary cells accessed from the resting breast (P&lt;0.05). Insulin expression in breastmilk cells correlated with expression of various stem cell genes, such as ESRRB, and appeared to be associated with the stage of lactation. We have for the first time confirmed that the insulin in breastmilk is derived from both the pancreatic beta cells and mammary cells of the lactating epithelium. Furthermore, mammary‐derived insulin may provide developmental signals within the mammary gland as well as contribute to breastmilk insulin.

Inflammatory breast cancer: a clinical diagnosis

I read the case report “Lactating breast abscess: a rare presentation of adenosquamous breast carcinoma” by Alipour et al(1) with great interest. The authors presented an interesting case of breast cancer in a lactating woman who presented with a longstanding breast abscess of two months’ duration. They have diligently reiterated the need to perform abscess wall biopsy in all atypical breast abscesses. They also ruled out the possibility of inflammatory breast cancer (IBC) on account of the absence of tumour emboli in the dermal lymphatics. However, I would like to stress that the presence of tumour emboli in the dermal lymphovascular spaces is neither sufficient nor required for the diagnosis of IBC. IBC is clinically diagnosed by a short duration of symptoms, typical clinical signs on examination of the affected breast, and pathological diagnosis of breast carcinoma either through skin biopsy or core/needle biopsy of the underlying lump, if present. Rapidly progressing diffuse erythema (pink or mottled pink hue) and oedema of more than one-third of the breast distinguishes IBC from noninflammatory locally advanced breast cancer (LABC) with skin involvement.(2,3) The breast oedema manifests as an increase in the size of the breast and exaggerated hair follicle pits, classically known as peau d’orange. These skin changes represent the dermal lymphatic obstruction, resulting from invasion by the tumour emboli; this phenomenon is considered a pathological hallmark of IBC.(4) It is necessary to highlight here why dermal lymphatic invasion by tumour emboli is not considered diagnostic of IBC. Firstly, dermal tumour emboli may not be identified in all cases of IBC despite adequate sampling of the skin, and secondly, dermal tumour emboli, though less numerous and smaller in size, may also be seen in noninflammatory LABC.(2) In a consensus statement, an international expert panel agreed that the following minimum criteria are required for the diagnosis of IBC: a history of rapid onset of breast erythema; a duration of history of no more than six months; oedema and/or peau d’orange and/or warm breast (with or without an underlying palpable mass); erythema occupying at least one-third of the breast; and pathological confirmation of invasive carcinoma.(4) However, the panel also strongly recommended that skin biopsy be done in all patients suspected to have IBC, as it may confirm the presence of dermal tumour emboli and may also give the pathological diagnosis of carcinoma if no underlying lump or regional metastatic lymphadenopathy is detected. A set of uniform diagnostic criteria for IBC, which can be used worldwide, will help medical practitioners obtain more accurate epidemiological data, and also provide better understanding of the clinicopathological profile and treatment outcomes of IBC across different geographical regions. Yours sincerely,