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- Breast abscess: infection of the breast bud or tissue associated with localized pus and inflammation
- Mastitis: infection of the breast tissue observed primarily during lactation
- 3–11% of women with breastfeeding mastitis develop a breast abscess.
- Affects primarily infants (peak age 1 to 6 weeks) and adolescents
- Bilateral abscesses, seen among neonates, are rare.
- Male-to-female ratio is 1:2 in neonates.
- In lactating teens, primiparity
- Gestational age >40 weeks
- Obesity, black race, tobacco use
- Avoid breast manipulation (including piercing).
- In lactating teens, establish good breastfeeding techniques.
- Recognize and treat mastitis early.
- Trauma, breast hypertrophy from maternal estrogen, or compromised host defenses enable spread of bacteria that often colonize the nasopharynx and umbilicus.
- The bacteria and/or its toxin, in turn, cause(s) subcutaneous destruction and loculated pus formation.
- Adolescents/adults: Trauma (e.g., sexual manipulation, nipple rings, tight-fitting bras, incorrect latching during breastfeeding), contiguous spread of a local infection (e.g., mastitis, acne), or underlying structural abnormalities (e.g., mammary duct ectasia, epidermal cysts) cause breast tissue edema and destruction by bacteria and/or its toxin.
- When mastitis is associated with breastfeeding, the inflammation inhibits milk release. The stasis of milk, in turn, may allow for bacterial proliferation.
- Newborn infection: Staphylococcus aureus (most common), group A or B Streptococcus, Bacteroides species, and gram-negative enteric bacteria, including Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Salmonella species
- Adolescent/adult infection: S. aureus (most common) with up to 19% being methicillin-resistant, E. coli, P. aeruginosa, Mycobacterium tuberculosis, Neisseria gonorrhoeae, and Treponema pallidum are infrequent pathogens.