Materiały źródłowe

• #1 Primary breast abscess – UpToDate

  https://www.uptodate.com/contents/primary-breast-abscess

  A breast abscess is a localized collection of inflammatory exudate (ie, pus) in the breast tissue. Breast abscesses develop most commonly when mastitis or cellulitis does not respond to antibiotic treatment, but an abscess can also be the first presentation of breast infection. It is an uncommon problem in breastfeeding with a reported incidence of 0.1 percent; the incidence among women with antibiotic-treated mastitis is 3 percent. Breast abscess can develop de novo (ie, primary; no inciting disease) or it can occur as a complication of another disease process (ie, secondary) such as periductal mastitis, skin infection over the breast, or granulomatous lobular mastitis. […] Primary breast abscesses develop as a complication of mastitis. A review of over 1300 patients with mastitis and breast abscesses showed 42 percent had lactational abscesses, and 47 percent had periductal (nonlactating) abscesses. The incidence of breast abscesses ranges from 0.4 to 11 percent of lactating parents. Breast abscesses in nonlactating women occurred more commonly in African Americans, those with obesity, and smokers.

• #2 Primary breast abscess – UpToDate

  https://www.uptodate.com/contents/primary-breast-abscess/print

  A breast abscess is a localized collection of inflammatory exudate (ie, pus) in the breast tissue. Breast abscesses develop most commonly when mastitis or cellulitis does not respond to antibiotic treatment, but an abscess can also be the first presentation of breast infection. […] Primary breast abscesses develop as a complication of mastitis. […] Risk factors for development of breast abscess as a complication of lactational mastitis include maternal age >30 years, first pregnancy, gestational age ≥41 weeks, and tobacco use. […] In a retrospective study of 68 patients all with breast abscess, smoking was a significant risk factor for the development of an abscess (odds ratio 8.0, 95% CI 3.4-19.4). […] Smoking was the only factor significantly associated with abscess recurrence.

• #3 Breast Abscess – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459122/

  Breast abscesses are a common problem, especially in lactating women. […] However, when a non-lactating patient presents with a breast abscess, a more nefarious etiology such as an inflammatory carcinoma should be considered. […] Lactational breast abscesses are most often caused by Staphylococcus aureus and Streptococcal species. Methicillin-resistant S. aureus is becoming increasingly common. Typically, non-lactational breast abscesses are a result of a mixed flora with S. aureus, Streptococcus, and anaerobic bacteria. […] To understand the pathophysiology of breast abscesses, you must understand the anatomy of the breast. The breast contains breast lobules, each of which drains to a lactiferous duct, which in turn empties to the surface of the nipple. There are lactiferous sinuses which are reservoirs for milk during lactation. The lactiferous ducts undergo epidermalization where keratin production may cause the duct to become obstructed, and in turn, can result in abscess formation. Abscesses associated with lactation usually begin with abrasion or tissue at the nipple, providing an entry point for bacteria. The infection often presents in the second postpartum week and is often precipitated in the presence of milk stasis. The most common organism known to cause a breast abscess is S. aureus, but in some cases, Streptococci, and Staphylococcus epidermidis may also be involved.

• #4 Breast Abscess – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK459122/

  Breast abscesses are a common problem, especially in lactating women. […] However, when a non-lactating patient presents with a breast abscess, a more nefarious etiology such as an inflammatory carcinoma should be considered. […] Lactational breast abscesses are most often caused by Staphylococcus aureus and Streptococcal species. Methicillin-resistant S. aureus is becoming increasingly common. Typically, non-lactational breast abscesses are a result of a mixed flora with S. aureus, Streptococcus, and anaerobic bacteria. […] To understand the pathophysiology of breast abscesses, you must understand the anatomy of the breast. The breast contains breast lobules, each of which drains to a lactiferous duct, which in turn empties to the surface of the nipple. There are lactiferous sinuses which are reservoirs for milk during lactation. The lactiferous ducts undergo epidermalization where keratin production may cause the duct to become obstructed, and in turn, can result in abscess formation. Abscesses associated with lactation usually begin with abrasion or tissue at the nipple, providing an entry point for bacteria. The infection often presents in the second postpartum week and is often precipitated in the presence of milk stasis. The most common organism known to cause a breast abscess is S. aureus, but in some cases, Streptococci, and Staphylococcus epidermidis may also be involved.

• #5 Breast abscess pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Breast_abscess_pathophysiology

  Breast abscess is the result of underlying inflammation (mastitis) in the breast skin. Injury may happen either during the lactation process from the infant or in the non-lactaion state of the patient as a cracking in the breast skin. This injury accelerates the entry of the causative bacteria which by its role form the abscess. […] In neglected cases, there may be necrosis in the abscess location leads to fibrosis, scarring and nipple retraction. […] Injured breast skin allows the entrance of the bacteria to the mammillary ducts. This bacteria can be from the infant or the mother herself. Overproduction of the breast milk with no flow to the infant forms an opportunistic field for the bacteria to cause infection. […] Breast Duct Ectasia: Metaplastic change of the duct cells can cause duct ectasia. This change causes widening of the ducts lining which leads to thickening of the ducts and obstruction. The ducts become filled with fluid which leads to nipple discharge and infection by the entrance of the bacteria and can form pus and abscess as a final result. […] Cracking in the skin will overtly help the bacteria to enter and form the abscess.

• #6 Breast abscess | nidirect

  https://www.nidirect.gov.uk/conditions/breast-abscess

  Breast abscesses are often linked to mastitis. […] If mastitis is not treated, it can lead to an abscess forming. […] White blood cells are sent to attack the infection. This causes tissue at the site of the infection to die. This creates a small, hollow area that fills with pus (an abscess).

• #7 Breast Abscesses and Masses: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/781116-overview

  The mammary glands arise from a caudal section of the ectodermal tissue known as the milk lines, which extend along the anterior surface of the developing fetus from the axilla to the groin. During puberty, pituitary and ovarian hormonal influences stimulate female breast enlargement, primarily owing to accumulation of adipocytes. Each breast contains approximately 15-25 glandular units known as breast lobules, which are demarcated by Cooper ligaments. Each lobule is composed of a tubuloalveolar gland and adipose tissue. Each lobule drains into the lactiferous duct, which subsequently empties onto the surface of the nipple. Multiple lactiferous ducts converge to form one ampulla, which traverses the nipple to open at the apex. […] When the lactiferous duct lining undergoes epidermalization, keratin production may cause plugging of the duct, resulting in abscess formation. This may explain the high recurrence rate (an estimated 39%-50%) of breast abscesses in patients treated with standard incision and drainage, as this technique does not address the basic mechanism by which breast abscesses are thought to occur.

• #8 Breast Abscess – Breast360.org

  https://breast360.org/topic/2017/01/01/breast-abscess/

  Subareolar abscesses may be caused by changes in the terminal ducts underneath the nipple. Cells may undergo squamous metaplasia, or flatten out, plugging up the ducts and obstructing them. This leads to a buildup of debris and secretions which become infected. […] The most frequent organisms seen are aerobic organisms, bacteria that live with oxygen, like Staph aureus, streptococcus and pseudomonas. Infections can also involves anaerobic bacteria, bacteria that live without oxygen, such as peptostreptococcus, propionibacterium and bacteroides.

• #9

  https://europepmc.org/books/n/statpearls/article-18595/?extid=30085548&src=med

  Lactational breast abscesses are most often caused by Staphylococcus aureus and Streptococcal species. Methicillin-resistant S. aureus is becoming increasingly common. Typically, non-lactational breast abscesses are a result of a mixed flora with S. aureus, Streptococcus, and anaerobic bacteria. […] To understand the pathophysiology of breast abscesses, you must understand the anatomy of the breast. The breast contains breast lobules, each of which drains to a lactiferous duct, which in turn empties to the surface of the nipple. There are lactiferous sinuses which are reservoirs for milk during lactation. The lactiferous ducts undergo epidermalization where keratin production may cause the duct to become obstructed, and in turn, can result in abscess formation. Abscesses associated with lactation usually begin with abrasion or tissue at the nipple, providing an entry point for bacteria. The infection often presents in the second postpartum week and is often precipitated in the presence of milk stasis. The most common organism known to cause a breast abscess is S. aureus, but in some cases, Streptococci, and Staphylococcus epidermidis may also be involved.

• #10 Clinical characteristics of lactational breast abscess caused by methicillin-resistant Staphylococcus aureus: hospital-based study in China | International Breastfeeding Journal | Full Text

  https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-021-00429-6

  This study aimed to identify the differences in clinical characteristics, puncture efficacy, antibiotic use, treatment duration, breastfeeding post-illness, and recurrence of patients with breast abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-susceptible Staphylococcus aureus (MSSA) infection during lactation. […] In recent years, the detection rate of MRSA in lactating patients has gradually increased. Whether the patients with MRSA-infected breast abscesses are more serious than those infected with MSSA or whether MRSA increases the difficulty of breast abscess treatment remains unclear. […] Our study shows that there were no statistically significant differences in the duration of treatment and the infection recurrence rate, which is consistent with the results of Chen CY et al. Our study also showed that MRSA infection did not increase the recurrence rate or prolong the treatment duration of patients with lactational breast abscesses compared with MSSA infection.

• #11 Clinical characteristics of lactational breast abscess caused by methicillin-resistant Staphylococcus aureus: hospital-based study in China | International Breastfeeding Journal | Full Text

  https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-021-00429-6

  Overall, in our study, patients who were infected by MRSA did not experience poorer treatment outcomes, as measured by duration of treatment, rate of recurrence, compared with those infected by MSSA. And there was no difference in clinical characteristics between breast abscesses infected by MRSA and those infected by MSSA, as assessed by maternal age, postpartum period, hospitalization rate, abscess cavity location, the number of abscess cavities and the amount of pus.

• #12 Breast Abscesses Caused by Anaerobic Microorganisms: Clinical and Microbiological Characteristics

  https://www.mdpi.com/2079-6382/9/6/341

  Breast abscesses constitute a clinical problem with a low overall incidence, and the majority of patients are managed in a community setting, mainly with antibiotics. They are localized infections caused by both aerobic and anaerobic microorganisms. This clinical entity usually occurs in women during lactation, and they have been traditionally considered a minor clinical problem. Non-puerperal breast abscesses, however, have been uncommonly described in the medical literature and may be predisposed to by smoking and commonly relapse. These two types of breast abscesses could have different presentations, risk factors, microbial agents, and treatments. […] The microbial etiology of breast abscesses has been previously published in different studies, and the main causative agents belong to the genera Staphylococcus, although other kinds of microorganisms have been implicated, such as Streptococcus, Enterococcus, and Enterobacteriaceae. However, in non-puerperal abscesses, a greater variability of microorganisms was found displaying mixed growth patterns. Regarding the anaerobic pathogens, in some locations, these microorganisms cause nearly a third of cases of breast abscesses, especially Bacteroides fragilis, and they can be the etiological agents both of mixed infections and those isolated in pure culture.

• #13 Breast Abscesses Caused by Anaerobic Microorganisms: Clinical and Microbiological Characteristics

  https://www.mdpi.com/2079-6382/9/6/341

  Regarding the anaerobic species isolated, the majority of previously reported studies found Finegoldia magna, Anaerococcus prevotii, and Parvimonas micra as the main etiologic agents of this entity. Moreover, in some studies, Bacteroides spp. and other Gram-negative anaerobic bacilli were found as the cause of breast abscesses. In a study, B. fragilis represents a third of all cases of breast abscesses. However, in another study, only two anaerobic cultures were positive for Propionibacterium acnes and Peptostreptococcus anaerobius. In the present report, we mainly isolated F. magna, Actinomyces spp., and Propionibacterium spp., followed by Prevotella spp. and Peptoniphilus spp. Surprisingly, no cases of Bacteroides spp. were observed in our series. […] There are few data on the risk factors associated with development of primary breast abscesses and recurrences. However, some of them seem to be implicated for development of this disease, especially tobacco smoking. Furthermore, nipple piercing is associated with increased risk of developing subareolar breast abscess. In some cases, subareolar abscesses have been linked to squamous metaplasia of the lactiferous ducts.

• #14 Abscess/infections/periareolar mastitis – Pesce – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6764/html

  A mammary duct fistula is a communication between the periareolar skin and a subareolar breast duct. Fistulae occur most commonly after ID of nonlactational breast abscesses, and patients usually have preceding episodes of recurrent abscess formation and report purulent discharge through the fistula opening. […] Patients most likely to have recurrent breast abscesses include smokers as well as older patients. A study looking at patients with recurrent peripheral breast abscesses showed that patients had a higher incidence of infections with mixed bacteria, anaerobes, and Proteus and a lower incidence of Staphylococcus, indicating a need for broader antibiotic coverage to be considered in this high risk population.

• #15 Primary breast abscess – UpToDate

  https://www.uptodate.com/contents/primary-breast-abscess

  Risk factors for development of breast abscess as a complication of lactational mastitis include maternal age >30 years, first pregnancy, gestational age ≥41 weeks, and tobacco use. Risk factors for a staphylococcal abscess in lactating parents in one study identified problems with breastfeeding (odds ratio 5.0) and being a lactating parent employed outside their home (odds ratio 2.74) as risk factors. […] In a retrospective study of 68 patients all with breast abscess, smoking was a significant risk factor for the development of an abscess (odds ratio 8.0, 95% CI 3.4-19.4). Of the 68 cases, over half (54 percent) needed multiple surgical treatments and 22 of these were heavy smokers. Five patients developed fistulas and all were heavy smokers. In another retrospective study of 89 patients with any type of breast abscess, 39 patients (43 percent) were heavy smokers. The majority of patients who developed recurrent abscesses were smokers (77 percent). Smoking was the only factor significantly associated with abscess recurrence.

• #16 Risk factors and prognosis of acute lactation mastitis developing into a breast abscess: A retrospective longitudinal study in China | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0273967

  The incidence of breast abscesses was higher in the central area of the nipple than in the peripheral region. Inflammation in the nipple and areola region is more likely to obstruct the main milk duct, making it difficult to discharge milk and more likely for breast abscesses to form. […] Our study showed that breast abscesses occur more frequently during the puerperium period (postpartum time in 42 days), which was associated with the mothers lack of breastfeeding experience. […] After the diagnosis of a breast abscess, open surgical drainage is traumatic, and patients experience pain when dressings are changed, which often leads to the discontinuation of breastfeeding. […] In conclusion, a body temperature38.5C, a postpartum time 42 days, an onset time 2 days, lesions in the nipple/areola area, a history of massage by non-professionals and bacterial cultures for milk or pus that test positive for Staphylococcus aureus or MRSA are risk factors for the occurrence of a breast abscess.

• #17 Breast abscess

  https://www.nhs.uk/conditions/breast-abscess/

  A breast abscess can form if you have a breast infection (called mastitis) and it’s not treated quickly. […] You’re more likely to get mastitis if you are breastfeeding. You can get it if you’re not breastfeeding, but this is less common. […] Getting treatment for mastitis as soon as possible can help reduce the risk of getting an abscess.

• #18 Breast abscess | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/breast-abscess?lang=us

  A breast abscess is defined as an inflammatory mass that drains purulent material either spontaneously or on incision. The predominant infectious organism is Staphylococcus aureus, often the penicillinase-producing and methicillin-resistant S. aureus. Other causative organisms include Staphylococcus epidermidis and Proteus mirabilis. […] Peripheral breast abscesses have generally been associated with mastitis during breastfeeding, but previous reports indicate that abscesses are common among non-lactating women. […] For clinical relevance and for planning treatment breast abscesses are classified as: puerperal abscesses: seen in primiparous mothers; non-puerperal central abscesses: commonest non-breastfeeding abscess, seen mostly in young women; especially smokers; non-puerperal peripheral abscesses: less commonly seen. Seen in older women with underlying chronic medical conditions like diabetes, rheumatoid arthritis; women taking steroids; or following recent breast intervention.

• #19 Risk factors and prognosis of acute lactation mastitis developing into a breast abscess: A retrospective longitudinal study in China | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0273967

  Breast abscess is developed on the basis of acute mastitis, which will cause damage to the physical and mental health of lactating women and is an important factor affecting the rate of breastfeeding. […] Risk factors for progression of mastitis to breast abscess include a body temperature38.5C, a postpartum time 42 days, an onset time 2 days, lesions in the nipple/areolar complex area, a history of massage by non-medical staff and bacterial cultures for milk or pus that test positive for staphylococcus aureus or MRSA (P 0.001). […] The most common pathogenic bacteria of mastitis and breast abscess is staphylococcus aureus. There are many risk factors for mastitis to develop into breast abscess. We should take effective measures for its risk factors and select sensitive antibiotics according to the results of bacterial culture to reduce the formation of breast abscess.

• #20 Breast abscess overview – wikidoc

  https://www.wikidoc.org/index.php/Breast_abscess_overview

  Following untreated mastitis, breast abscess could occur. Breast abscess is usually caused by staphylococcus aureus bacterial infection to an injured breast skin. Staphylococcus aureus could form abscess by secretion of several killing agents like enzymes and toxins which causes breast tissue necrosis. In a reaction to these bacterial substances, assembled white blood cells in this tissue produces anti-bacterial anti-bodies that help in killing the bacteria. However, these cells cause damage to the soft tissue contributing in the abscess formation. […] As the breast abscess is the complicated form of mastitis, the pathophysiology is mostly like the mastitis pathophysiology.

• #21 Bacteriological profile of breast abscess and its antimicrobial susceptibility at tertiary care hospital – IJMMTD

  https://www.ijmmtd.org/html-article/23496

  Once inside the ampulla of the duct, staphylococci induce milk clotting, allowing the bacteria to proliferate within the clot. Initially, the affected breast, or often just a portion of it, exhibits signs of acute inflammation as a generalized cellulitis, which eventually progresses to form an abscess. Abscesses commonly develop in Staphylococcus aureus skin and soft tissue infections as a way to localize the infection. Neutrophils, the main immune cells responsible for fighting Staphylococcus aureus, release antimicrobial agents that kill bacteria but may also cause tissue damage and contribute to abscess formation. In response, Staphylococcus aureus secretes molecules that encourage abscess formation by attracting neutrophils, breaking down host cells, and aiding in creation of a fibrin capsule around the abscess.

• #22 Mastitis and Breast Abscess | Oncohema Key

  https://oncohemakey.com/mastitis-and-breast-abscess/

  Breast abscess is a common clinical problem. Management of these patients can be challenging and requires an understanding of pathophysiology and microbiology to achieve optimal outcomes. […] The cause and sequence of this benign disease process appears to be multifactorial, and the exact mechanism of the pathogenesis of this disease has been speculated. The disease progression hypothesis for a subareolar breast abscess is thought to begin with an abnormal change of the normal cuboidal lining of the lactiferous ducts into squamous metaplasia. The squamous epithelium then produces keratin, which in turn plugs the ducts, leading to obstruction. This accumulation of cellular debris produces dilatation of the duct and eventual rupture. The debris and secretory material infiltrate the surrounding tissue creating an inflammatory response in the breast tissue, and subsequent bacterial invasion results in abscess formation.

• #23 Mastitis and Breast Abscess | Oncohema Key

  https://oncohemakey.com/mastitis-and-breast-abscess/

  The development of a subareolar abscess is a spectrum of varying degrees of duct ectasia, followed by a primary chemically induced inflammatory reaction, and secondary bacterial growth, subsequently followed by an infection and chronic periductal inflammation. The development of a chronic mammary fistula is thought to be the final stage of a benign but complicated inflammatory process termed mammary ductassociated inflammatory disease sequence (MDAIDS). […] The main organisms cultured most commonly are mixed flora of aerobes and anaerobes consisting of S. aureus, coagulase-negative staphylococci, Streptococcus, and anaerobes.

• #24

  https://europepmc.org/books/n/statpearls/article-18595/?extid=30085548&src=med

  Because of the heterogeneity in management methods of breast abscess, there is, in fact, not enough data to state if needle aspiration is a better option than incision and drainage for a breast abscess. In addition, it is not known if an antibiotic should always be administered to women undergoing incision and drainage or aspiration. The few case series available reveal that the outcome for most women is excellent with any of these methods, but it is not known which is superior. However, with all three methods, recurrence of breast abscess is common. Thus, it is highly recommended that a standardized interprofessional approach be developed to manage breast abscess, lower the rates of recurrence, and improve outcomes.

• #25 Breast Abscess – Zero To Finals

  https://zerotofinals.com/surgery/breast/breastabscess/

  A breast abscess is a collection of pus within an area of the breast, usually caused by a bacterial infection. […] Pus is a thick fluid produced by inflammation. It contains dead white blood cells of the immune system and other waste from the fight against the infection. When pus becomes trapped in a specific area and cannot drain, an abscess will form and gradually increase in size. […] Mastitis caused by infection may precede the development of an abscess. […] Smoking is a key risk factor for infective mastitis and breast abscesses. Damage to the nipple (e.g., nipple eczema, candidal infection or piercings) provides bacteria entry. Underlying breast disease (e.g., cancer) can affect the drainage of the breast, predisposing to infection. […] The key feature that suggests a breast abscess is a swollen, fluctuant, tender lump within the breast. Fluctuance refers to being able to move fluid around within the lump using pressure during palpation.

• #26 Mastitis and breast abscess – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1084

  Breast infections (including infectious mastitis and breast abscess) more commonly affect women aged 15-45 years, especially those who are lactating. However, mastitis and breast abscess can occur at any age. […] Staphylococcus aureus is the most frequent pathogen isolated. […] Prompt and appropriate management of mastitis usually leads to a timely resolution and prevents complications, such as a breast abscess. […] Breast abscess requires both the removal of pus and antibiotic therapy. Interventions can include aspiration and incision and drainage procedures. […] It is imperative to identify and treat any underlying co-existent causes of infection to facilitate resolution and prevent recurrence. It is also necessary to exclude breast carcinoma. […] A breast abscess is a localised area of infection with a walled-off collection of purulence. It may or may not be associated with mastitis. […] prolonged mastitis (breast abscess) […] prior breast abscess (breast abscess) […] vaginal manipulation (breast abscess)

• #27 Mastitis and breast abscess – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1084

  Breast infections (including infectious mastitis and breast abscess) more commonly affect women aged 15-45 years, especially those who are lactating. However, mastitis and breast abscess can occur at any age. […] Staphylococcus aureus is the most frequent pathogen isolated. […] Prompt and appropriate management of mastitis usually leads to a timely resolution and prevents complications, such as a breast abscess. […] Breast abscess requires both the removal of pus and antibiotic therapy. Interventions can include aspiration and incision and drainage procedures. […] It is imperative to identify and treat any underlying coexistent causes of infection to facilitate resolution and prevent recurrence. It is also necessary to exclude breast carcinoma. […] A breast abscess is a localized area of infection with a walled-off collection of purulence. It may or may not be associated with mastitis. […] prolonged mastitis (breast abscess) […] prior breast abscess (breast abscess) […] vaginal manipulation (breast abscess)

• #28 Breast Abscesses Caused by Anaerobic Microorganisms: Clinical and Microbiological Characteristics

  https://www.mdpi.com/2079-6382/9/6/341

  The optimal treatment of breast abscesses remains a controversial issue, but recent evidence supports the need for a drainage procedure or an image-guided percutaneous aspiration. Obtaining an appropriate sample is a guarantee for a correct etiological diagnosis. Until now, few studies have focused on cases of breast abscesses due to anaerobes. In the present report, we analyze the clinical data and antimicrobial susceptibility of all breast abscesses produced only by anaerobes in our hospital over the last few years. […] There are few studies focused on microbiologic and clinical characteristics of breast abscesses caused only by anaerobic microorganisms. Here, we reported the antimicrobial susceptibility and clinical characteristics of 35 clinically relevant anaerobic bacteria isolated from breast abscess samples. Although staphylococci are the main causative agents in this clinical entity, anaerobic bacteria may play a role in some circumstances. Over the study period, in our case, 49 aerobic microorganisms (mainly S. aureus) were isolated from breast abscesses (65%), whereas 35 anaerobic pathogens were isolated (35%). This result is higher than those obtained in other previously published studies and in our own department 25 years ago. Moreover, other authors found that the anaerobes were more frequently encountered in recurring breast abscesses.

• #29 Breast Abscesses and Masses: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/781116-overview

  The recurrence rate of breast abscess is high (39%-50%) when treated with standard incision and drainage, and studies have shown even higher recurrence rates in women undergoing fine-needle aspiration. Nonpuerperal abscesses recur more frequently, especially when associated with non-staphylococcal species (50% recurrence rate).

• #30 Abscess/infections/periareolar mastitis – Pesce – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6764/html

  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. […] 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. […] Periareolar infections are the most difficult breast infections to treat, and up to half of patients experience recurrent episodes of infection. Due to the important role of smoking in this disease, it is important to encourage smoking cessation. 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. The only effective long-term treatment for these women is removal of all the affected ducts by total duct excision.

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