A 14 week post natal women presents with fluctuant breast swelling. What should be the treatment
Bacterial mastitis Most commonly associated with lactation in majority of cases Causative organism--mostly S.aureus. Ascending infection from a sore and cracked nipple may initiate the mastitis Or lactiferous ducts will first become blocked by epithelial debris leading to stasis. Once within the ampulla of the duct, staphylococcus cause clotting of milk and within this clot organisms multiply. Clinical features: The affected breast or more usually a segment of it presents the classical signs of acute inflammation. Early on this is a generalised cellulitis but later an abscess will form Treatment: During cellulitis stage--patient should be treated with an appropriate antibiotic, such as flucloxacillin or coamoxiclav.Feeding from the affected side may continue if the patient can manage. Suppo of the breast, local heat and analgesia will help to relieve pain If an antibiotic is used in the presence of undrained pus, an antibioma may form. This is a large sterile, brawny oedematous swelling that takes many weeks to resolve. At present advice is repeated aspirations under antibiotic cover (if necessary ultrasound for localisation) be performed. This often allows resolution without the need for an incision and will also allow the patient to continue breast feeding. Presence of pus can be confirmed by needle aspiration and the pus should be sent for bacteriological culture.
Incision and drainage
Continue breast feeding with antibiotics
Analgesics
Repeated aspiration under antibiotic cover
Endocrinology and breast