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AccessSurgery's Quick Test lets you test your surgical knowledge and anonymously compare your results to those of your peers. Sign up for our free AccessSurgery e-newsletter and twice a month Quick Test will appear in your email inbox. Quick Test is developed by Gerard M. Doherty, MD, AccessSurgery's Editor-in-Chief, from the site's online resources. Your results will be ranked against those of your peers.
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Quick Test posted on 12.12.11:
| Inflammatory Breast Conditions
| Bacterial Infection
Staphylococcus aureus and Streptococcus species are the organisms most frequently recovered from nipple discharge from an infected breast. Breast abscesses are typically seen in staphylococcal infections and present with point tenderness, erythema, and hyperthermia. These abscesses are related to lactation and occur within the first few weeks of breast-feeding. Staphylococcal infection can result in subcutaneous, subareolar, interlobular (periductal), and retromammary abscesses (unicentric or multicentric), necessitating operative drainage of fluctuant areas. Preoperative ultrasonography is effective in delineating the extent of the drainage procedure, which is best accomplished via circumareolar incisions or incisions paralleling Langer's lines. While staphylococcal infections tend to be more localized and may be located deep in the breast tissues, streptococcal infections usually present with diffuse superficial involvement. They are treated with local wound care, including warm compresses, and the administration of intravenous antibiotics (penicillins or cephalosporins). Breast infections may be chronic, possibly with recurrent abscess formation. In this situation, cultures are taken to identify acid-fast bacilli, anaerobic and aerobic bacteria, and fungi. Uncommon organisms may be encountered and long-term antibiotic therapy may be required.
Hospital-acquired puerperal infections of the breast are much less common now, but nursing women who present with milk stasis or noninfectious inflammation may still develop this problem. Epidemic puerperal mastitis is initiated by highly virulent strains of methicillin-resistant S. aureus that are transmitted via the suckling neonate and may result in substantial morbidity and occasional mortality. Pus frequently may be expressed from the nipple. In this circumstance, breast-feeding is stopped, antibiotics are started, and surgical therapy is initiated.
|  | | Breast abscesses. Sagittal view of the breast with sites of potential abscess formation. Deep abscesses may be multilocular and may communicate with subcutaneous or subareolar sites. Insert depicts drainage of a multilocular breast abscess through circumareolar incisions and other incisions that parallel Langer's lines. |
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