Abstract
Introduction: Subareolar breast abscess has the tendency to recur and result in mammary fistula. The ideal management of subareolar abscess needs a clear understanding of the underlying pathological changes in the ducts and the clinicopathological progress of events that ultimately result in mammary fistula. We present our experience with 35 cases of subareolar abscess with respect to recurrence pattern and management outcomes.
Materials and Methods: This is a retrospective descriptive study conducted in Raja Muthiah Medical College, chidambaram during june 2014 to october 2017. All new patients with clinically or radiologically proven subareolar breast abscess were chosen. Those with breast cancer, immunocompromised status, peripheral breast abscess, Tuberculous mastitis were excluded. History, clinical and radiological examination findings, microbiological profile, treatment given and outcomes like number of recurrence, time to recurrence were recorded and analyzed.
Results: Out of 35 new cases of subareolar abscess, all were females in age range 18-60 years, only 2 patients gave history of passive smoking. More than 90% of patients had underlying duct ectasia in either one or both breasts. Organisms were isolated in 14 out of 33 patients, mostly Staphylococci. Incision and Drainage with antibiotics was the commonly performed procedure. The average number of recurrence was 1.8 (range 0 to 3) and the average time to recurrence was 3 months (15 days to 18 months).
Conclusion: Incision and drainage alone is insufficient for optimal management of subareolar abscess. The underlying duct has to be excised partially or totally to prevent development of mammary fistula and nipple inversion.
Keywords: subareolar abscess, duct ectasia, duct excision.
References
- Meguid MM, Kort KC, Numann PJ, Oler A. Sub-areolar abscess: The penultimate stage of Mammary Duct associated Inflammatory Disease Sequence. In: Bland KI, Copeland EM, Klimberg VS . Philadelphia., Elsevier Inc.. The Breast: Comphrehensive management of benign and malignant diseases . 5TH 2009 -; pg94 – 134.
- Meguid MM, Oler A, Numann PJ, Khan S. Pathogenesis-based treatment of recurring subareolar breast abscesses. Surgery1995; 118:775–782 [Crossref] [Medline]
- Utor, D. A., Moreno, P., Granados, M. C., & Reina, R. (2011). Review of the current techniques in use for the treatment of mammary duct-associated inflammatory disease sequence (MDAIDS) in males taking into account two new cases. Breast Dis. 2011-2012;33(4):149-57. doi: 10.3233/BD-2012-000339.
- Bundred, N. J., Dover, M. S., Coley, S., & Morrison, J. M. (1992). Breast abscesses and cigarette smoking.British journal of surgery, 79(1), 58-59. https://doi.org/10.1002/bjs.1800790121
- Haagensen CD : Mammary duct ectasia: a disease that may simulate carcinoma , cancer 4:749, 1951.
- Edmiston CE Jr, Walker AP, Krepel CJ, Gohr C. The nonpuerperal breast infection: aerobic and anaerobic microbial recovery from acute and chronic disease. J Infect Dis1990; 162:695–699
- Kasales, C. J., Han, B., Smith Jr, J. S., Chetlen, A. L., Kaneda, H. J., & Shereef, S. Nonpuerperal mastitis and subareolar abscess of the breast :American Journal of Roentgenology. 2014;202: W133-W139. 10.2214/AJR.13.10551
- Bharat A, Gao F, Aft RL, Gillanders WE, Eberlein TJ, Margenthaler JA. Predictors of primary breast abscesses and recurrence. World J Surg2009; 33:2582–2586 [Crossref] [Medline]
- Versluijs-Ossewaarde FN, Roumen RM, Goris RJ. Subareolar breast abscesses: characteristics and results of surgical treatment. Breast J2005; 11:179–182 [Crossref] [Medline]
- Ekland DA, Zeigler MG, Abscess in the Nonlactating Breast:Arch Surg. 1973;107(3):398-401.doi:10.1001/archsurg.1973.01350210034011
- Hanavadi S, Pereira G, Mansel RE. How mammillary fistulas should be managed. Breast J2005; 11:254–256 [Crossref] [Medline]
- Taffurelli M, Pellegrini A, Santini D, Zanotti S, Simone DD, Serra M: Recurrent periductal mastitis: Surgical treatment: Surgery: https://doi.org/10.1016/j.surg.2016.06.048
- Maier WP, Berger A, Derrick BM. Periareolar abscess in the nonlactating breast. Am J Surg 1982; 144:359–361.
Corresponding Author
Prema Mariappan
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.97
