Abscess/infections/periareolar mastitis

: Breast infections can be considered lactational or nonlactational, and the guiding principle in treating breast infection is to give antibiotics as early as possible to stop abscess formation. Lactational abscesses are usually caused by Staphylococcus aureus, including MRSA, often due to trauma during breastfeeding. A combination of repeated aspirations and oral antibiotics is usually effective at resolving abscess formation and is the current treatment of choice. Women should be encouraged to continue breastfeeding. Rarely, surgical drainage of lactational abscesses is required, and the development of milk fistula is uncommon. Nonlactational abscess are considered central (periareolar) or peripheral. Periareolar abscesses are common in young women and smokers, and up to half of patients experience recurrent episodes of infection. The underlying cause of recurrent infections is obstructed lactiferous ducts by keratin plugs, and therefore a subareolar abscess will continue to recur unless these ducts are excised by total duct excision. Often, a mammary duct fistula can form due to recurrent infection treated by incision and drainage (I&D), and treatment is again surgical consisting of either opening up the fistula tract and leaving it to granulate or excising the fistula and affected ducts and closing the wound primarily. Peripheral breast abscesses are less common, and most recently treatment has shifted from open surgical drainage to less invasive repeated aspirations using ultrasound-guidance. Advantages to percutaneous aspiration include shorter healing time and improved cosmetic outcomes. For women older than 35 years old and/or at risk for breast cancer, management of breast infections should not forgo recommended screening, and upon resolution of symptoms mammography is recommended.