Sandbox: Breast Abscess
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Synonyms and keywords: Mammary abscess
Overview
Historic Perspective
Classification
Breast Abscess may be classified according to anatomical location, clinical presentation and lactation state of the patient into subtypes.[1]
- Anatomical location: subcutaneous, subareolar, interlobular, central and retromammary.
- Lactation state: Lactational and Non-Lactational.
- Clinical presentation: primary and secondary.
Pathophysiology
Following untreated Mastitis, breast abscess could occur. Breast abscess is usually caused by staph aureus bacterial infection to an injured breast skin. The bacteria produces killing substances that necrotize the tissue. In a reaction to these bacterial substances, assembled white blood cells in this tissue produces anti-bacterial bodies that help in killing the bacteria. However, these cells cause damage to the tissue forming abscess as well. As the breast abscess is the complicated form of mastitis, the pathophysiology is mostly like the mastitis pathophysiology.[2]
Pathogenesis
Breast abscess is the result of underlying inflammation (Mastitis) in the breast skin. Injury may happen either during the lactation process from the infant or in the non-lactaion state of the patient as a cracking in the breast skin. This injury accelerates the entry of the causative bacteria which by its role form the abscess. [3]
- Lactational:
- Injured breast skin allows the entrance of the bacteria to the mammillary ducts. This bacteria can be from the infant or the mother herself. Overproduction of the breast milk with no flow to the infant forms a good field for the bacteria to cause infection.[4]
- Breast Duct Ectasia: metaplastic change of the duct cells can cause duct ectasia. This change causes widening of the ducts lining which leads to thickening of the ducts and obstruction. The ducts become filled with fluid which leads to nipple discharge and infection by the entrance of the bacteria and can form pus and abscess as a final result. [5]
- Non-Lactional:
- Non lactational breast abscess is less common than lactational form. It can be subgrouped into central, peripheral and skin associating.
- Cracking in the skin will overtly help the bacteria to enter and form the abscess.
Gross Pathology
Microscopic Pathology
Causes
Breast abscess is a bacterial infectious disease that is caused by many bacterial pathogens. It is almost caused by the same pathogens causing mastitis. To understand the common species causing breast abscess we can classify them into gram +ve and gram -ve bacteria. [6]
[7]| Bacterial pathogens causing breast abscess | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Gram +ve | Gram -ve | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Staphylococcus Aureus (Most common cause of the lactational abscess) •MRSA •Coagulase -ve Staphylococcus Aureus | Streptococcus pyogens | Lactobacillus | Clostridium | Veillonella | Bacteroids | Escherishia Coli | Enterobacteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Epidemiology
Breast abscess is a rare disease that may occur due to improper treatment of the mastitis. Only 5-11 percent of the patients with mastitis may be infected by abscess.[8]
Age
- Patients of all age groups may develop breast abscess.
- It is more common in the younger more than the elder.
- It is common in neonates with mastitis as approximately 50 percent of the neonatal patients with mastitis can develop breast abscess.
References
- ↑ Dixon JM (1994). "ABC of breast diseases. Breast infection". BMJ. 309 (6959): 946–9. PMC 2541130. PMID 7755694.
- ↑ Kobayashi SD, Malachowa N, DeLeo FR (2015). "Pathogenesis of Staphylococcus aureus abscesses". Am J Pathol. 185 (6): 1518–27. doi:10.1016/j.ajpath.2014.11.030. PMC 4450319. PMID 25749135.
- ↑ Kataria K, Srivastava A, Dhar A (2013). "Management of lactational mastitis and breast abscesses: review of current knowledge and practice". Indian J Surg. 75 (6): 430–5. doi:10.1007/s12262-012-0776-1. PMC 3900741. PMID 24465097.
- ↑ Marchant DJ (2002). "Inflammation of the breast". Obstet Gynecol Clin North Am. 29 (1): 89–102. PMID 11892876.
- ↑ Bundred NJ, Dixon JM, Lumsden AB, Radford D, Hood J, Miles RS; et al. (1985). "Are the lesions of duct ectasia sterile?". Br J Surg. 72 (10): 844–5. PMID 4041720.
- ↑ Dabbas N, Chand M, Pallett A, Royle GT, Sainsbury R (2010). "Have the organisms that cause breast abscess changed with time?--Implications for appropriate antibiotic usage in primary and secondary care". Breast J. 16 (4): 412–5. doi:10.1111/j.1524-4741.2010.00923.x. PMID 20443790.
- ↑ Kaneda HJ, Mack J, Kasales CJ, Schetter S (2013). "Pediatric and adolescent breast masses: a review of pathophysiology, imaging, diagnosis, and treatment". AJR Am J Roentgenol. 200 (2): W204–12. doi:10.2214/AJR.12.9560. PMID 23345385.
- ↑ Whitaker-Worth DL, Carlone V, Susser WS, Phelan N, Grant-Kels JM (2000). "Dermatologic diseases of the breast and nipple". J Am Acad Dermatol. 43 (5 Pt 1): 733–51, quiz 752-4. doi:10.1067/mjd.2000.109303. PMID 11050577.