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Mastitis and breast abscess

Last reviewed: 28 Aug 2024
Last updated: 13 Jun 2024

Summary

Definition

History and exam

Key diagnostic factors

  • fever
  • decreased milk outflow
  • breast warmth
  • breast tenderness
  • breast firmness
  • breast swelling
  • breast erythema
  • flu-like symptoms, malaise, and myalgia
  • breast pain
  • breast mass
  • fistula
Full details

Other diagnostic factors

  • nipple discharge
  • nipple inversion/retraction
  • lymphadenopathy
  • extra-mammary skin lesions
Full details

Risk factors

  • female sex
  • poor breast-feeding technique
  • lactation
  • milk stasis
  • nipple injury
  • previous mastitis
  • prolonged mastitis (breast abscess)
  • women aged >30 years (breast abscess)
  • prior breast abscess (breast abscess)
  • shaving or plucking areola hair
  • anatomical breast defect, mammoplasty, or scar
  • other underlying breast condition
  • nipple piercing
  • foreign body
  • skin infection
  • Staphylococcus aureus carrier
  • immunosuppression
  • hospital admission
  • breast trauma
  • primiparity (breast abscess)
  • multiparity
  • overabundant milk supply
  • complications of delivery
  • maternal stress
  • tight clothing
  • antifungal nipple cream
  • fibrocystic breast disease
  • cigarette smoking
  • vaginal manipulation (breast abscess)
  • antiretroviral therapy
Full details

Diagnostic tests

1st tests to order

  • breast ultrasound
  • diagnostic needle aspiration drainage
  • cytology of nipple discharge or sample from fine-needle aspiration
  • milk, aspirate, discharge, or biopsy tissue for culture and sensitivity
Full details

Tests to consider

  • pregnancy test
  • blood culture and sensitivity
  • histopathologic examination of biopsy tissue
  • mammogram
  • milk for leukocyte counts and bacteria quantification
  • CBC
Full details

Treatment algorithm

ACUTE

lactational mastitis

nonlactational mastitis

breast abscess

ONGOING

breast abscess post acute intervention

recurrence of mastitis and/or breast abscess

Contributors

Authors

Jesse Casaubon, DO, FSSO​, FACS

Breast Surgical Oncologist

Baystate Health

Springfield

MA

Disclosures

JC declares that he has no competing interests.

Acknowledgements

Dr Jesse Casaubon would like to gratefully acknowledge Dr Holly S. Mason, Dr Jose A. Martagon-Villamil, Dr Daniel Skiest, Dr Gina Berthold, and Dr Liron Pantanowitz, previous contributors to this topic.

Disclosures

HSM, JAMV, DS, and GB declare that they have no competing interests. LP is a co-author of references cited in this topic.

Peer reviewers

Edward Sauter, MD, PhD

Program Officer

National Institutes of Health

National Cancer Institute

Rockville

MD

Disclosures

ES declares that he has no competing interests.

Justin Stebbing, MA, MRCP, MRCPath, PhD

Consultant Medical Oncologist/Senior Lecturer

Department of Medical Oncology

Imperial College/Imperial Healthcare NHS Trust

Charing Cross Hospital

London

UK

Disclosures

JS declares that he has no competing interests.

William C. Dooley, MD

The G. Rainey Williams Professor of Surgical Oncology

University of Oklahoma

Oklahoma City

OK

Disclosures

WD declares that he has no competing interests.

  • Mastitis and breast abscess images
  • Differentials

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  • Guidelines

    • ABM clinical protocol #36: the mastitis spectrum​​
    • ABM clinical protocol #36: the mastitis spectrum
    More Guidelines
  • Patient information

    Mastitis in breastfeeding women

    Mastitis: breastfeeding advice

    More Patient information
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