Microbial infections of breast tissue. It is usually caused by cracks in the nipple during breastfeeding (lactation).

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

Antibiotic treatment can be applied if there is no abscess yet but only signs of infection.

If an abscess develops, it must be drained (emptied). This can be done with a needle or sometimes open surgical drainage may be required. In any case, antibiotic treatment should be continued for a long time.

Inflammation of the breast (Lactational Mastitis):

The most common postpartum period for breastfeeding mothers is the 1st postpartum period. Inflammation of the breast can develop up to once a week. Cracks, sores, scabs and poor hygiene caused by breastfeeding lead to the growth of germs in the nipple. If such cases are not treated with antibiotics, mastitis may develop in one third.

In such cases, continuing breastfeeding or emptying the milk with the help of a pump reduces abscess formation. If an abscess develops in the inflammation in the breast, it must be drained surgically.

Periductal Mastitis

It is a mastitis that occurs in the non-breastfeeding breast. It is a type of inflammation that starts around the nipple and develops around the milk ducts. A very large proportion is associated with smoking. It is thought to develop because smoking damages the milk ducts behind the nipple, making the area a favorable ground for infections.

Initially, it is only possible to treat the disease with antibiotics. If an abscess is detected on ultrasound-guided breast examination or similar imaging tests, abscess drainage is required.

Since the risk of recurrence after drainage is high, surgical intervention to remove the milk ducts behind the nipple is often performed in recurrent cases.

Abscesses (peripheral non-lactational breast infections) may develop in areas distant from the nipple in patients with diabetes, chronic renal failure, chemotherapy, immunosuppressed and debilitated patients. In this case, the treatment should include draining the abscess and antibiotic treatment. Depending on the age and examination findings of the patients, if cancer is suspected on imaging tests, a biopsy must be taken from the abscess or inflamed area.

Granulomatous Mastitis

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

Tuberculosis mastitis is more common in developing countries like Turkey and in immunocompromised patients (such as AIDS, chronic renal failure). In tuberculous mastitis, clinical presentations such as fistula in the form of an abscess in the breast skin, mass in the breast, draining mass or abscess in the armpit are seen.

For diagnosis, samples from the abscess or mass must be tested for tuberculosis. In patients whose tests for tuberculosis are negative, if recurrent breast abscesses are seen despite abscess drainage and antibiotherapy and there is clinical suspicion, a tuberculosis that cannot be diagnosed with tests may be considered and drug treatment and antibiotics are applied. In tuberculous mastitis that recurs despite frequent abscess drainage and drug treatment, surgical removal of the abscess area from the breast may be considered.

Idiopathic granulomatous lobular mastitis is common in patients of young childbearing age. It is thought to be caused by an above normal reaction of the immune system to the breast (autoimmune). Past infection or trauma may also be among the causes.

Both clinically and radiologically (ultrasonography, mammography, magnetic resonance imaging), it is often confused with breast cancer (especially inflammatory breast cancer) and tuberculous mastitis. Recurrent breast abscesses occur despite antibiotherapy.

Tuberculosis tests are negative in abscess or tissue samples. The differential diagnosis from cancer in USG, MMG, breast MRI examinations is quite difficult and requires experience. For a definitive diagnosis, the suspicious breast tissue must be sent to pathology.

In treatment, patients with early stages and small masses can be observed for a short period of time. Such masses may disappear spontaneously only during observation with antibiotics and pain medication.

If large or multiple masses are present, immunosuppressive drugs such as steroids may be started. Patients should be checked at 3-week intervals during treatment. It is very important to make sure that the patient does not have tuberculosis before starting such immunosuppressive drugs. If the masses respond to cortisone treatment, they can be surgically removed completely. If there is no response to cortisone, other drugs that suppress the immune system may be tried.