Breast Infection Wirsma Arif Harahap Surgical Oncologist Oncology Division – Surgery Department

Epidemiology Affects women between the ages of 18 and 50 years. In the adult : lactational or nonlactational. Infection can also affect the skin overlying the breast, and occurs either as a primary event or secondary to a lesion in the skin, such as a sebaceous cyst, or a more generalized condition, such as hidradenitis suppurativa.

LACTATIONAL INFECTION Caused by S. aureus, but it can also be caused by Staphylococcus epidermidis and Streptococcus species. the patient has a history of a cracked nipple or a skin abrasion, which results in a break in the body's defense mechanisms and an increase in the number of bacteria over the skin ofthe breast. bacteria enter the breast through the nipple and infect poorly draining segments.

Clinical Symptoms commonly occurs following a flrst pregnancy in the first 6 weeks of breast-feeding or during weaning. pain, erythema, swelling, tenderness, or systemic signs of infection. The breast is swollen, tender, and erythematous; if an abscess is present, a fluctuant mass with overly- ing shiny, red skin. Axillary lym- phadenopathy is not usually a feature. Patients can be toxic with pyrexia, tachycardia, and leukocytosis

Treatment Antibiotics given at an early stage usually control the infection and stop abscess formation. > 80% of staphylococci are resistant to penicillin, flucloxacillin or amoxicillin-clavulanate are given. except in patients with a penicillin sensitivity : erythromycin or clarithromycin is usually effective. Tetracycline, ciprofloxacin, and chloramphenicol should not be used to treat infection in breast- feeding women because they enter breast milk and may harm the child

Abcess  aspiration by usg guide. a small incision (mini-inci- sion) is made over the point of maximal fluctuation, and the pus is drained. The cavity can be irrigated with local anes- thetic solution, which produces instant pain relief. Irrigation is continued daily until the incision site closes. If the skin overly- ing the abscess is necrotic, the necrotic skin is excised, which allows the pus to drain. Breast- feeding should be continued if possible because this promotes drainage ofthe engorged segment and helps resolve infection. Beware : inflamatory cancer

The infant is not harmed by bacteria in the milk, nor by flu- cloxacillin, amoxicillin-clavulanate,or ervthromvcin. Only rarely is it necessary to suppress lactation with cabergoline in patients with breast infection.

Non Lactational Infection Nonlactational infections can be divided into those occurring centrally in the breast in the periareolar region and those affecting peripheral breast tissue

Periareolar lnfection Periareolar infection is most commonly seen in young women; the mean age of occurrence is 32 years, and most are ciga- rette smokers. Location : near or beneath nipple areolar complex. Assc : nipple retraction. Complication : abcess, mammary duct fistula

Peripheral Nonlactational Breast Abscess Peripheral nonlactational breast abscesses are less common than periareolar abscesses and have been reported to be associated with a variety of under$ing disease states, such as dia- betes, rheumatoid arthritis, steroid treatment, and trauma. S. aureus is the organism usually responsible, but some abscesses contain anaerobic organisms.

Tuberculous Mastitis tuberculosis more commonly reaches the breast ihrough lymphatic spread from axillary, mediasti- nal, or cervical nodes or directly from underlying structures such as the ribs. Tuberculosis predominantly affects women in the latter part of their childbearing years' An axillary or breast sinus 1s present in up to 50% of patients. The most common presenlation is that of an acute abscess resulting from infection of an area of tuberculosis by pyogenic organisms. Treatment is with local surgery and antitubercular drug therapy.

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