Infections: Mastitis and Abscesses

Mastitis is a condition in which a woman’s breast tissue becomes abnormally swollen or inflamed. It is usually caused by an infection of the breast ducts. It occurs most commonly in women who are breastfeeding. As it progresses, mastitis can cause the formation of a breast abscess. This is a localized collection of pus within breast tissue.

Periductal mastitis can make the breast feel tender and hot to the touch, and the skin may appear reddened. It can also lead to a discharge from the nipple, which can be either bloody or non-bloody.
Sometimes a lump can be felt behind the nipple or the breast tissue behind the nipple can become scarred. This can pull the nipple inwards so it becomes inverted. Occasionally an abscess (a collection of pus) or a fistula (a tract that develops between a duct and the skin) may develop.
People who smoke have an increased risk of being affected by periductal mastitis, because substances in cigarette smoke can damage the ducts behind the nipple. Smoking can also slow down the healing process after treatment.

During breastfeeding women are more prone to abscesses because

  • Blockage of a milk duct because of which milk builds up within the breast and causes inflammation and may result in infection.
  • Sore or cracked nipples
  • Using only one position to breastfeed

Treatment

Antibiotics and painkillers will be given initially
If you develop an abscess and/or a fistula, your specialist will decide the best way to treat it. This may involve using a fine needle and a syringe to draw off (aspirate) the pus using an ultrasound scan for guidance. This may need to be repeated (over a period of time) until all the pus has been removed.
Sometimes an incision and drainage has to be done in which an opening is made in the skin to allow the pus to be drained. This usually requires a general anaesthetic.
If periductal mastitis doesn’t get better after taking antibiotics, or if it comes back, you may need to have an operation to remove the lump formed which has affected the ducts.

Many times it could be granulomatous mastitis, which is more difficult to treat and needs long-term therapy.