Cellulitis/Mastitis (of the Breast)

CELLULITIS WHAT IS IT?

Infection of the skin of the breast.

WHAT IS THE CAUSE?

• Nonsurgical wounds to the breast including body piercing, tattooing or animal bites
• Women with breast cancer who have had surgery and/or who have undergone radiation or chemotherapy can experience a delayed cellulitis.

WHAT ARE THE SIGNS AND SYMPTOMS?

• Sudden onset.
• Skin is mildly swollen, red and warm to touch.
• Breast tenderness or pain.
• Fever and chills are rare.
• A palpable mass or change on mammogram or ultrasound is rarely detectable.

WHAT IS THE TREATMENT?

• Notify your physician as soon as possible to prevent further spread of the infection.
• Antibiotics.  Some cases require intravenous (IV) antibiotics because of their severity.
• Manage pain with analgesics such as Tylenol or by applying a cold pack to the breast.
• Wear a well fitting bra and minimize vigorous activities to prevent pain caused by movement.
• Cellulitis can be recurrent and require treatment multiple times.

Inflammatory breast cancer, a rapidly progressing type of breast cancer with a high mortality rate, typically has many of the same symptoms as cellulitis.  Inflammatory breast cancer is often misdiagnosed as cellulitis, resulting in many weeks of antibiotic therapy and observation. By the time the correct diagnosis is made the cancer may have already spread.  If signs and symptoms of cellulitis do not resolve within 2-3 weeks then inflammatory cancer needs to be ruled out quickly.

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MASTITIS WHAT IS IT?

Infection of the breast.

Two types:

• Lactational Mastitis: Infection of the breast diagnosed during pregnancy or while lactating (breast feeding).
• Non-lactational Mastitis: Infection of the breast diagnosed in women who are not pregnant or lactating.

WHAT IS THE CAUSE?

With lactational mastitis the source of the infection is bacteria from the mouth or nose of a nursing infant.  Bacteria enters the nipple, moves to into ducts and begins to grow in milk (an excellent growing medium) blocked in any ducts.  Women are more vulnerable during the first month of breast feeding when the nipples more likely to be damaged and at weaning when breasts more likely to be engorged. Pregnant or lactating women should practice good hygiene, implement measures to reduce cracked nipples, and prevent blocked milk ducts by not prolonging times between breast feeding and avoiding very tight fitting bras.

With non-lactational mastitis the source of infection is usually bacterial as well.  Women who smoke, have a breast condition called ductal ectasia, are diabetic or are immunosuppressed may be at higher risk.

WHAT ARE THE SIGNS AND SYMPTOMS?

• Breast becomes swollen, red and warm to touch
• Breast pain
• Chills or fever (temperature above of 38.5 °C)
• Flu-like symptoms with fatigue
• Development of a breast abscess (collection of pus)

WHAT IS THE TREATMENT?

• Notify your physician as soon as possible to prevent further spread of infection.
• Ultrasound assessment to determine if an abscess is present.
• Antibiotics.
• Needle drainage of any abscess with or without ultrasound guidance.  This is done to remove pus and to obtain sample for bacteriological testing.
• Surgical drainage of an abscess or excision of the infected area under local anaesthetic sometimes required.
• Manage pain with analgesics such as Tylenol or by applying a cold pack to the breast.
• Wearing a well fitting bra and minimizing vigorous activities to prevent pain caused by movement.

After mastitis, the affected area of you breast may have a change in texture.  Some changes may show up on mammogram as microcalcifications.  Inform your mammogram technologist of your history with mastitis.