Breast inflammation and abscess

Who to refer:

This is no routine pathway.

• Worsening mastitic inflammation with or without clinical breast abscess, not responding to oral antibiotics should be referred to the on-call breast and general surgeon for assessment, IV antibiotics and/or drainage.

• Refer urgently to breast clinic when there is persistent or recurrent mastitic inflammation not responding to a course of antibiotics, including signs of dermal lymphatic obstruction (skin thickening appearance of ‘peau d’orange’ suspicious for malignancy).

Who not to refer:

• Benign mastitis and recognised cause, resolving completely with antibiotics
• Troublesome breast skin lesions include nipple-sparing eczematous rash (trial of topical steroid cream), symptomatic sebaceous cyst, hydradenitis suppuritiva (infected sweat glands causing boils eg. obesity causing IMF background diabetes, polycystic ovarian syndrome) and seborrhoeic keratosis. In addition to lesions suspicious for basal cell or squamous carcinoma, these may be referred to dermatology particularly if chronic and/or recurrent.
• Alternatively, there is a general surgery minor lesions clinic. Since lesions might appear on the breast skin region, as always, please take the opportunity to check that the patient is up to date with screening mammography as they may contact NHS screening service to reschedule a missed appointment.

How to refer:

SCI Gateway:

Borders General Hospital -> General Surgery – Breast -> B Breast Referral

Please examine the patient and differentiate superficial localised ‘dermatological’ infection from benign, painful, generalised ‘mastitis’ with/without localised swelling of ‘abscess’ and ‘suspicious inflammation’ or skin thickening without common benign causes of lactation and smoking.

In the event of benign mastitis and recognised cause, resolving completely with antibiotics, please take a breast family history and check the patient is up to date with NHS screening mammograms.

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