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Acute Breast Sepsis


Definition

Cellulitis affecting the interlobular tissue of the breast, usually caused by an acute bacterial infection.

Clinical presentation includes:

  • short duration of skin erythema
  • tenderness
  • indurated tissue

Refer immediately if (considering acute surgical team if systemically unwell)

  • Systemically unwell
  • Obvious abscess
  • Necrotic/compromised skin

Initial Primary Care Management

  • Lactational - High dose Flucloxacillin or Clarithromycin for 10-14 days
  • Non lactational - Augmentin or clarithromycin for 10-14 days
  • Review at 48 hours
  • If improving complete course
  • If deteriorating refer
  • If referral criteria are not met, but resolution of symptoms are slow or recurrent, refer for full triple assessment via 2-week wait proforma.
  • If patient > 50yrs, (Increased risk of underlying malignancy) also consider referral via 2-week wait.

Referral Process

  • All acute breast abscess to come through acute surgical admission
  • Where the patient can be accommodated, they will be assessed within 24 hours by the breast surgical team.
  • If imaging demonstrates a pus collection, then depending on abscess, size, location and skin integrity, as well as patient preference, it will be drained by incision and drainage or repeated aspiration.
  • If imaging does not show a collection the patient will be returned to your care. If previous breast disease, patient family history or clinical presentation warrants a higher index of suspicion for underlying malignancy, then the patient will undergo formal triple assessment and you will receive correspondence regarding this.

If out of office hours or patient unwell, contact on call surgical team to arrange assessment and onward referral to the breast team.


 Reference: pathway author Rachel English, specialist registrar breast surgery                     BMJ 2011; 342:d396