Breast Abscess and Masses Follow-up

  • Author: Andrew C Miller, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Sep 2, 2010
 

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.
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Further Outpatient Care

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). Other choices are dicloxacillin 500 mg PO qid or cephalexin 500 mg PO qid for 10-14 days. 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.[22]

Screening tests

  • The United States Preventive Services Task Force (USPSTF) has updated their guidelines regarding screening mammography. The USPSTF recommends screening mammography every other year for women aged 50-74 years;[23] however, the American Cancer Society continues to recommend screening mammography every year for women aged 40-74 years.[5]
  • Patients should discuss specific benefits and harms surrounding screening mammography with their physician and an individual decision should be made regarding when to start screening mammography.
  • Women older than age 75 years should have an in-depth discussion with their physician to consider the risks and benefits of screening mammography, and decisions to start, stop, or continue screening mammography should be individualized.
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Inpatient & Outpatient Medications

  • Prescribe pain medication to patients with a breast abscess as necessary. NSAIDs, such as ibuprofen, are preferred because they are not transferred through breastmilk. 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.
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Transfer

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

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Contributor Information and Disclosures
Author

Andrew C Miller, MD  Fellow, Department of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center (UPMC); Attending Physician, Department of Emergency Medicine, UPMC St Margaret's Hospital

Andrew C Miller, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Tajinderpal S Saraon, MD  Cardiology Fellow, Department of Cardiovascular Disease, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Sadia Hussain, MD  Resident Physician, Department of Emergency Medicine, State University of New York, Downstate, Kings County Hospital

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.

Specialty Editor Board

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, 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: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Barry J Sheridan, DO  Chief Warrior in Transition 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.

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

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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.

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Ultrasonogram demonstrates a hypoechoic mass with smooth, partially lobulated margins typical of a fibroadenoma.
Craniocaudal mammograms obtained 1 year apart demonstrate a newly developing mass in the outer part of the breast.
Spot compression mammogram of the outer part of the breast demonstrates a new mass as smooth, margined, and oval. The findings are consistent with a fibroadenoma, a cyst, or a malignancy. In this patient, the diagnosis was a rapidly growing fibroadenoma.
Eggshell or rim calcifications (arrows) have walls thinner than those of lucent-centered calcifications.
This mass with associated large, coarse calcifications (arrows) is a degenerating fibroadenoma.
Breast cancer, ultrasonography. Mediolateral oblique digital mammogram of the right breast in a 66-year-old woman with a new, opaque, irregular mass approximately 1 cm in diameter. The mass has spiculated margins in the middle third of the right breast at the 10-o'clock position. Image demonstrates both the spiculated mass (black arrow) and separate anterior focal asymmetry (white arrow).
Breast cancer, ultrasonography. Antiradial sonogram of the spiculated mass (shown in the image above) demonstrates a hypoechoic mass with angular margins (black arrows). Cursors on the margins of the mass were used to electronically measure its dimensions of the mass, which was 0.9 X 0.8 cm.
 
 
 
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