Mastitis with Breast Abscess: Managing the Discrete Tender Lump
Clinical Scenario
This protocol covers mastitis complicated by a breast abscess — a localised collection within breast tissue that presents as a discrete, tender lump in the breast. The lump may feel tense or fluctuant on examination, distinguishing this presentation from uncomplicated mastitis.
Breast Abscess
A breast abscess is a localised collection in the breast tissue resulting in a painful breast lump. It is potentially secondary to bacterial mastitis that is rapidly progressive or not managed expeditiously. Beyond the systemic signs of mastitis, the hallmark finding is a discrete tender lump — which may be tense or fluctuant — requiring targeted management.
Clinical Goal
The aim is for inflammation of the breast to settle within 24–48 hours of initiating management, with review scheduled to confirm response.
Approach (partial overview)
Where specialist resources are available, the first-line approach involves a procedure to drain the abscess collection alongside antibiotic cover. The choice of antibiotic is guided by microbiological findings. The complete regimen — including the full sequence of steps and additional management — is detailed in the structured protocol.
References
- A breast abscess, a localised collection in the breast tissue that results in a painful breast lump, is potentially secondary to bacterial mastitis that is rapidly progressive or is not managed expeditiously.
- Breast abscess is characterised by symptoms similar to mastitis, with the additional sign of a discrete tender lump, which may be tense or fluctuant.
- Aspiration with antibiotic cover is a safe first line approach where specialist breast clinics or ultrasound guidance are available.
- For abscess – guided by microbiological culture and sensitivity.
- Women with mastitis should be reviewed within 24–48 hours to ensure that the inflammation is settling.
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