• Infection is most often due to Staphylococcus aureus in newborn infants and in adolescents.
• In newborns, Escherichia coli, Pseudomonas aeruginosa, and Group B Streptococcus, should also be considered.
• In adolescents, tuberculosis, Neisseria gonorrhea, and syphilis must also be considered. Trauma (sexual manipulation, nipple rings), mammary duct ectasia, epidermal cysts, mastitis and acne are predisposing factors.

• Potentially pathogenic bacteria may colonize the skin and move retrograde into the ducts and deeper tissues.
• In newborns, breast hypertrophy secondary to maternal hormones appears to increase the risk of breast abscess formation. Abscesses are usually unilateral.

• Most often neonates, 1 to 5 weeks old
• Neonatal male to female ratio is 1:2
• Occur in 2% of all postpartum women

• Bacteremia and sepsis, especially in newborns
• Cellulitis
• Necrotizing fasciitis
• Destruction of mammary gland with scar formation

• Excellent, with appropriate treatment

• Cellulitis
• Mastitis

• Fat necrosis with painless, firm, circumscribed, mobile mass
• Contusion with firm tender poorly defined mass
• Hematoma as a sharply defined mass withecchymosis

• Mondor disease is a superficial phlebitis in the skin, often due to trauma (e.g., a biopsy), which resolves spontaneously.
• Carcinoma

Question: Manipulation of breast, trauma, a sudden onset of swelling, warmth, tenderness, and erythema are often reported.
Significance: Signs of infection

Question: Fever, irritability, nipple discharge?
Significance: Signs of infection

• Breast tissue may have fluctuance, warmth, swelling, erythema and tenderness
• Fever
• Purulent nipple discharge
• Regional adenopathy

• Nipple discharge from aspirates or incisional specimens, and send for bacterial culture.
• In neonates, send blood for bacterial culture to rule out bacteremia; consider full sepsis work-up. Consider culturing the throat and nose for evidence of colonization by S. aureus.

• Ultrasound as needed

• Neonates: IV Oxacillin or other b-lactamase resistant penicillin, with or without an aminoglycoside
• Adolescents: IV b-lactamase resistant penicillin (oxacillin, methicillin)

• Incision and drainage if fluctuance present
• Warm compresses
• For adolescents, who are breast-feeding infants, continued expression of milk is necessary to avoid engorgement and areas of milk stasis

• Neonates: 10 to 14 days of oral antibiotics, given at home
• Adolescents: more than 14 days total of antibiotics

• Expect improvement within 48 hours of initiation of intravenous antibiotics
• Need to follow all patients closely given the risk of recurrence

• Superficial phlebitis can be confused with a breast abscess
• Fever is not always present on presentation

Q: Is fluctuance always found on examination?
A: No, yet breast swelling and/or warmth/erythema is nearly universally present.

Q: Is fever necessary for the diagnosis?
A: No, not always present at time of presentation.

Q: May a mother continue to breastfeed if she has a breast abscess?
A: The 1997 Red Book recommendations are to discontinue breast feeding from the affected breast, but the unaffected breast may be used for breast feeding. After treatment is complete, the affected breast can be utilized in breast feeding again.

American Academy of Pediatrics. Peter G, ed. 1997 red book: report of the Committee on Infectious Diseases, 24th ed. Elk Grove Village, IL: American Academy of Pediatrics;1997: 74.

Bailey LA, Waecker NJ Jr. Pseudomonas aeruginosa mastitis in a neonate. Pediatric Infect Dis J 1993;12(1):104.

Bodemer C, Panhans A, Chretien-Marquet B, Cloup M, Pellerin D, de Prost Y. Staphylococcal necrotizing fasciitis in the mammary region in childhood: a report of five cases. J Pediatrics 1997;131(3):466–469.

Bodsworth NJ, Price R, Nelson MJ. A case of gonococcal mastitis in a male. Genitourin Med 1993;69:222–223.

Greydanus DE, Parks DS, Farrell EG. Breast disorders in children and adolescents. Pediatr Clin North Am 1989;36(3):601–638.

Walsh M, McIntosh K. Neonatal mastitis. Clin Pediatr 1986;25:395–399.