YES: Admission to Surgical Assessment

NO: Outpatient management

• Refer to on call General Surgery Consultant (x 1302) OR Registrar (#1301)
• If recent breast surgery, contact operating Consultant

• Oral antibiotics (see below)
• Send OP IUR to Highland Breast Unit if persists after 7 days treatment or concerned about malignancy
• Needle aspiration of superficial abscesses in primary care if experienced and confident to do so

Red, hot, painful breast ONLY

Red, hot, painful breast with ABSCESS +/- skin necrosis

Lactational Mastitis

Management:

• Advise mother to KEEP FEEDING or expressing on the affected side as this is most effective drainage. See Mastitis, Prevention and Treatment Policy
• If baby unable to attach to affected breast, encourage
  expressing of the breast at least 8 times in 24 hours
• Consider a warm or cool compress for symptomatic
  relief but ensure not too hot
• Consider antibiotics if symptoms persist or worsen after
  12 to 24 hrs (see below)

Non-lactational
mastitis

Management:

• Antibiotics as per guidelines
  (see below)
• Add anaerobic cover if smoker
• Consider a warm or cool compress for symptomatic
  relief, but ensure not too hot

Breast Abscess

Management:

• Is there an obvious drainable collection?
  Percutaneous drainage with 21G needle or above
• Use image guidance if implant present
• Send aspirate for culture and sensitivity
• Antibiotics as per guidelines (see below)
• Is there skin necrosis present?
  Consider I&D with skin debridement under GA.

Recurrent abscesses or necrotic lesions may be related to PVL producing Staph aureus, including MRSA. Seek advice from Microbiology

Abscess: 7 to 10 days

Mastitis: 10 to 14 days

YES: Plan for home

NO

• Consider step down from IV to oral, if clinically well
• Outpatient appointment with Breast Surgeons if
  concerned about underlying malignancy

• Request USS Breast for assessment of deeper collection. Discuss with Breast Surgeon or Breast Radiologist
• Discuss current antibiotic therapy with Microbiology