-Breast Abscess-
-A breast abscess is a localized collection of purulent material that develop usually as a result of mastitis
-Do not have to be lactating to develop breast abscess
-Signs and symptoms of breast abscess is painful inflammation of the breast associated with malaise, along with fever and tender fluctuant mass
-Primary treatment of breast abscess is incision and drainage
-If an abscess is suspected an ultrasound should be done to confirm and help localize the pocket of purulent material
-In the absence of MRSA risk factors, empiric therapy with cephalexin or dicloxacillin should begun.
-With MRSA risk factors bactrim or clindamycin should be initiated.
-In the setting of severe infection vancomycin should be given
-Subaerolar breast abscess with a retracted nipple should raise the possibility of anaerobic infection and should start augmentin or clindamycin
-Women should continue breast feeding
-Breast Fibroadenoma-
-Simple fibroadenomas are benign sold containing tumors that have some glandular as well as fibrous tissue
-Multiple fibroadenomas can occur on the same breasts or bilaterally
-Etiology of fibroadenomas is not known but thought to be hormonal. They persist during the reproductive years, can increase in size during pregnancy or with estrogen therapy, and regress in menopause
-Fibroadenomas are usually found between the ages of 15-35
-With complex fibroadenomas there is an increase risk of breast cancer
-Physical exam usually reveals a well defined mobile mass, and a solid mass on ultrasound
-It is not necessary to excise biopsy proven fibroadenomas
-If a presumed fibroadenoma is symptomatic or increases in size, then incision is mandatory to rule out malignant change
-Rapid growth increases the suspicion for phyllodes tumor
-Fibrocystic Disease-
-Fibrocystic disease is breast pain that is attributed to fibrocystic changes
-The pain may be cyclical with the menstrual cycle hormone changes
-The terminology of the breast exam is nodular sensitive breast
-These are considered normal physiologic changes
-Patients should have regular mammograms and surveillance
-Mastitis-
-Mastitis is the localized inflammation of the breast tissue that may or may not be accompanied by infection
-Three major classifications of mastitis: infections, non infectious, and mastitis associated with malignancy
-Infectious mastitis can include simple mastitis or complicated mastitis (abscess formation)
-Lactational mastitis is the most common form of mastitis
-Non infectious mastitis can be from post irradiation mastitis, periductal mastitis, and idiopathic granulomatous mastitis
-Lactation mastitis best treated with cephalexin or augmentin
-If MRSA is suspected use bactrim
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