Thursday, August 19, 2010

Primary Breast Abscess Risk Factors

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active.

A recent article in the July issue of the Journal of the American College of Surgeons (full reference below) looked at the risk factors for developing a breast abscess.
It is a case control study of 68 patients with a primary breast abscess. Several (36/68) developed a recurrence as defined by the need for repeated drainage within 6 months.
They found
Univariate analysis indicated that smoking (odds ratio [OR] 8.0 [95% CI 3.4 to 19.4]), obesity (OR 3.6 [95% CI 1.5 to 9.2]), diabetes mellitus (OR 5.7 [95% CI 1.1 to 54.9]), and nipple piercing (OR 10.2 [95% CI 1.3 to 454.4]) were significant risk factors for development of primary breast abscess.
Recurrent breast abscess occurred in 36 (53%) patients. Multivariate logistic regression identified significant OR for an increase in recurrence related to age (OR 1.08 [95% CI 1.01 to 1.15] per year), smoking (OR 14.73 [95% CI 3.18 to 68.22]), surgical treatment (11.94 [95% CI 1.08 to 131.72]), and a decrease in recurrence after MRSA infections (OR 0.02 [95% CI 0.00 to 0.72]).
I think perhaps this article has too small a number of individuals, but find their numbers interesting.
The eMedicine overview (second reference below) does not even address possible infections from nipple piercing, suggesting:
Mastitis is usually seen in lactating women, but the presence in a nonlactating woman should spur evaluation for an inflammatory carcinoma or new-onset diabetes.6
Causes of primary breast infections are most likely to be Staphylococcus aureus and streptococcal species. Nonpuerperal abscesses typically contain mixed flora (S aureus, streptococcal species) and anaerobes.
The eMedicine article does recognize a correlation between breast infection and smoking:
A study by Schafer et al found a significant correlation between cigarette smoking and subareolar breast abscess.12
So while the article may have a small number of individuals, it is probably safe to say that being overweight, having diabetes mellitus, and smoking all make your risk of having a breast infection higher. By how much is more difficult to say.
Risk Factors for Development and Recurrence of Primary Breast Abscesses; Vinod Gollapalli, Junlin Liao, Amela Dudakovic, Sonia L. Sugg, Carol E.H. Scott-Conner, Ronald J. Weigel; Journal of the American College of Surgeons - July 2010 (Vol. 211, Issue 1, Pages 41-48, DOI: 10.1016/j.jamcollsurg.2010.04.007)
Breast Abscess and Masses; eMedicine article, May 13, 2010; Andrew C Miller, MD, Tajinderpal S Saraon, MD, and Mark A Silverberg, MD, FACEP, MMB


#1 Dinosaur said...

I saw a patient with what I thought was a breast abscess: a new painful breast lump with a normal mammogram 9 months earlier. It didn't respond to antibiotics, so I sent her for surgical drainage. The surgeon took her to the OR for what he thought was going to be a percutaneous procedure, but something didn't look right. When he went in, he found an inflammatory cancer. She died about 2 years later. Gave me a whole new respect for the "breast abscess".

DHS said...

#1Dino: do you attempt conservative treatment of breast abscesses? I've become a convert to ultrasound guided aspiration +- insertion of percutaneous drain by IR.

I admitted a 13yo with a breast abscess recently. She had been punched by her friend and it was actually an infected haematoma.