eMedicine Specialties > Emergency Medicine > Infectious Diseases

Breast Abscess and Masses: Follow-up

Author: Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center
Coauthor(s): Tajinderpal S Saraon, MD,, Chief Resident, Department of Internal Medicine, State University of New York Downstate Medical Center; Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Contributor Information and Disclosures

Updated: Apr 30, 2009

Follow-up

Further Inpatient Care

  • Consider admitting patients with large or complex breast abscesses for pain management, parenteral antibiotic therapy, and definitive management.
    • Treatment may include incision, drainage, and fistulectomy in the operating room.
    • The wound can be left to close by secondary intention or with simple sutures over a drain.

Further Outpatient Care

  • Breast mass: Timely follow-up with primary physician and surgeon, mammography, and possible needle biopsy of the mass are indicated.
  • Mastitis: Antibiotic therapy for 10-14 days, warm compresses, and continued breast emptying by breastfeeding or breast pumping q2h or when engorged is indicated. In breastfeeding mothers, use beta-lactamase stable penicillin (since breastfeeding). Dicloxacillin 500 mg PO qid or cephalexin 500 mg PO qid for 10-14 days are other choices. Instruct patients who are lactating that continued breastfeeding from the affected breast is not harmful to the baby. For nonpuerperal mastitis, use clindamycin 600 mg IV q8h or 300 mg PO q6h, or amoxicillin/clavulanate 500 mg PO tid.20

Inpatient & Outpatient Medications

  • Prescribe pain medication to patients with a breast abscess as necessary. NSAIDs, such as ibuprofen, are preferred as they are not transferred through breast milk. Preparations combining acetaminophen with codeine, oxycodone, or hydrocodone may be used depending on the level of discomfort.
  • Prescribe parenteral narcotics for pain control while awaiting definitive surgical therapy.
  • Continue antibiotic therapy for 14 days after drainage. 

Transfer

  • Transfer typically is not necessary for patients with breast mass, abscess, or mastitis.

Complications

  • Breast mass - Chronic pain, scarring or disfigurement, metastases, postsurgical complications (eg, ipsilateral lymphedema), and death.
  • Breast abscess - Recurrent or chronic infection, scarring.
  • Mastitis - Breast abscess formation in less than 10% of cases.

Prognosis

  • Breast mass: Prognosis varies from excellent in patients with a fibroadenoma to poor in those with inflammatory breast cancer. Influencing factors include tumor size, histology, nodal involvement, distant metastases, and comorbid conditions.
  • Breast abscess: Unfortunately, the recurrence rate of breast abscess is high (39-50% when treated with standard I&D). Studies of patients with fistulectomy have lower recurrence rates.
  • Mastitis: Most patients experience resolution within 2-3 weeks.  All patients with symptoms that have not resolved within 5 weeks should be evaluated for resistant infection or malignancy.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to arrange proper follow-up care for patients with newly diagnosed breast mass
  • Failure to recognize need for drainage in patients with breast abscess
  • Obstetrician-gynecologists, family practitioners, and internists constitute the largest group of defendants in litigation cases concerning breast cancer; cases involving the failure to diagnose breast cancer account for half of all breast cancer malpractice claims.21
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Howard A Blumstein, MD, and Amy K Rontal, MD, to the development and writing of this article.



More on Breast Abscess and Masses

Overview: Breast Abscess and Masses
Differential Diagnoses & Workup: Breast Abscess and Masses
Treatment & Medication: Breast Abscess and Masses
Follow-up: Breast Abscess and Masses
References
Further Reading
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Further Reading

Clinical guidelines

 Breast cancer screening. American College of Obstetricians and Gynecologists (ACOG). Breast cancer screening. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2003 Apr. 12 p. (ACOG practice bulletin; no. 42). [94 references]

Common breast problems. University of Michigan Health System. Common breast problems. Ann Arbor (MI): University of Michigan Health System; 2007 Oct. 10 p. [7 references]

ACR Appropriateness Criteria® palpable breast masses. Parikh JR, Evans WP, Bassett L, Berg WA, D/Orsi C, Farria DM, Herman CR, Kaplan SS, Liberman L, Mendelson E, Edge SB, Expert Panel on Women's Imaging - Breast. Palpable breast masses. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 4 p. [30 references]

ACR Appropriateness Criteria® nonpalpable breast masses. D'Orsi CJ, Bassett LW, Berg WA, Bohm-Velez M, Evans WP III, Farria DM, Lee C, Mendelson EB, Goldstein S. Nonpalpable breast masses. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 12 p. [25 references]

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Keywords

breast mass, breast lump, breast abscess, breast cancer, mastitis, malignant breast disease, benign breast mass, breast infection, fibrocystic disease, fibroadenoma, malignant breast mass, postpartum mastitis, in situ lobular or ductal cancer, intraductal papilloma, infiltrating ductal carcinoma, inflammatory carcinoma, fibroadenoma

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Contributor Information and Disclosures

Author

Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center
Andrew C Miller, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians, American Medical Association, Emergency Medicine Residents Association, Islamic Medical Association of North America, Medical Society of the State of New York, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Tajinderpal S Saraon, MD,, Chief Resident, Department of Internal Medicine, State University of New York Downstate Medical Center
Disclosure: Nothing to disclose.

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Schering  Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Barry J Sheridan, DO, Chief, Department of Emergency Medical Services, Brooke Army Medical Center
Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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