•           Mastitis is a cellulitis of the interlobular connective tissue within the mammary gland, which can result in abscess formation and septicaemia.

•           Mastitis is a complication often encountered in primiparous women and develops in 1% to 24% of breastfeeding women. A breast abscess develops as a complication of mastitis in 5% to 11 % of cases. The most common bacteria is Staphylococcus aureus.

•           Differentiating between mastitis and abscess can be difficult; when there is suspicion for abscess, the woman should be referred for ultrasound evaluation.

•           Mastitis on ultrasound will appear as an ill-defined area of altered echotexture with increased echogenicity in the infiltrated and inflamed fat lobules

•           The diagnosis of abscess requires identification of a hypoechoic collection, often with a thick echogenic periphery.

•           Common clinical symptoms of breast infection include pain, redness, and increased temperature.

•           Ultrasound is the first-line investigation because it is relatively pain less and, provides guidance for percutaneous drainage.

Treatment

A.  Mastitis Phase

•           Tab. Erythromycin 500 mg 3 times a day for 7 days.

•           Oral cephalosporins or clindamycin hydrochloride are excellent choices to cover the most common organisms

•           Tab. Diclofenac 50 mg BD

B.    Where an abscess has formed, aspiration of the pus, preferably under ultrasound control, has now supplanted open surgery as the first line of treatment. Antibiotics should be continued to reduce systemic infection and local cellulitis.

C.    Open surgical drainage may be necessary for patients with loculated collections or for those who have failed conservative management with antibiotic therapy and percutaneous drainage.

After open surgical drainage of an abscess, suckling may be difficult for a few days mechanical reasons on the affected side, but the mother should be encouraged to feed on unaffected side. The infected breast, however, should be emptied either by manual expression or by pump until such time as feeding can be recommenced. The mothers with breast abscesses should be encouraged to continue breastfeeding.

If lactation is to be suppressed cabergoline is preferred over bromocriptine.

D.  Patient education

Good hygiene and avoidance of breast engorgement or cracked nipple are important.

During pregnancy, daily washing will remove the dried secretions that will otherwise collect on the nipple.

After feeding the infant, the nipples should be dried and any segments of the breast that have not been adequately emptied during feeding expressed