Breast Infections

These are microbial infections of the breast tissue. They usually occur due to cracks in the nipple during breastfeeding.

Symptoms of breast infection include hardness, redness, pain, and increased skin temperature.

Antibiotic treatment may be administered only if an abscess has not yet formed and only if there are signs of infection.

If an abscess has developed, it must be drained. This can be done with a needle, but sometimes open surgical drainage may be necessary. In all cases, antibiotic treatment must be continued for an extended period.

Breast Inflammation (Lactational Mastitis):

Breast inflammation can develop in breasts in breastfeeding mothers, most commonly in the first week after birth. Cracks, sores, crusting, and poor hygiene caused by breastfeeding can lead to an infection in the nipple. In such cases, if not treated with antibiotics, one-third of the mothers may develop mastitis.

In such cases, continuing to breastfeed or pumping the milk can reduce the formation of an abscess. If an abscess develops in the breast, surgical drainage is necessary.

Periductal Mastitis:

This is a type of mastitis that occurs in the breast outside of breastfeeding. It can cause swelling around the nipple. It's a type of inflammation that begins in the milk ducts and develops around them. It's largely associated with smoking. It's thought to develop because smoking damages the milk ducts behind the nipple, making the area susceptible to infection.

Initially, the disease can be treated with antibiotics alone. If an abscess is detected during an ultrasound-guided breast examination or similar imaging tests, abscess drainage is necessary.

Because the risk of recurrence after drainage is high, in frequently recurring cases, surgical intervention to remove the milk ducts behind the nipple is performed.

Abscesses (peripheral non-lactation breast infections) may develop in areas distant from the nipple in patients with diabetes, chronic renal failure, chemotherapy, or immunosuppression. In these cases, treatment includes drainage of the abscess and antibiotic treatment. Depending on the patient's age and examination findings, and if cancer is suspected on imaging tests, a biopsy of the abscess or inflamed area should be performed.

Granulomatous Mastitis:

There are two types: tuberculous mastitis and idiopathic lobular granulomatous mastitis. It is found.

Tuberculosis mastitis is more common in developing countries like ours and in patients with suppressed immune systems (such as AIDS, chronic renal failure). Clinical symptoms of tuberculous mastitis include a fistula in the breast skin, a mass in the breast, a discharge-filled mass in the armpit, or an abscess.

For diagnosis, samples taken from the abscess or mass must be subjected to tuberculosis testing. If patients with negative tuberculosis tests experience recurrent breast abscesses despite abscess drainage and antibiotic therapy, and if there is clinical suspicion, tuberculosis that cannot be diagnosed with tests may be considered, and targeted drug treatment and antibiotics are administered. In cases of recurrent tuberculous mastitis despite treatment, surgical removal of the abscessed area from the breast may be considered.

Idiopathic granulomatous lobular mastitis is common in young women of childbearing age. It is thought to be caused by an abnormal immune response (autoimmune) to the breast. Previous infection or trauma may also be among the causes.

It is frequently confused with breast cancer (especially inflammatory breast cancer) and tuberculous mastitis, both clinically and radiologically (ultrasound, mammography, magnetic resonance imaging). Recurrent breast abscesses are observed despite antibiotic therapy.

Tuberculosis tests are negative in samples taken from the abscess or tissue. Differentiating the diagnosis from cancer with ultrasound, MMG, and breast MRI is quite difficult and requires experience. For a definitive diagnosis, any suspicious breast tissue removed must be sent to pathology.

During treatment, patients with early-stage or small lumps may be observed for a short time. Such lumps may disappear on their own with only antibiotics and pain medication.

If there are large or multiple lumps, immunosuppressive medications such as steroids may be initiated. Patients should be monitored at three-week intervals throughout treatment. It is crucial to ensure that the patient does not have tuberculosis before starting these immunosuppressive medications. If the masses respond to cortisone treatment, they can be completely removed surgically.If there is no response to tisone, other drugs that suppress the immune system can be tried.