Editing Breast abscess (section)

== '''Differential diagnosis''' ==

* Lactating women:
** Plugged duct
** Galactocoele - soft cystic mass that won't be tender. Can diagnose based on aspiration of milk.
* All women:
** Inflammatory breast cancer. Consider this if the infection does not resolve with appropriate treatment (one week antibiotics), or in non-lactating post-menopausal women without any precipitating factors or systemic signs of infection. Skin thickening due to oedema, erythema, peau d'orange appearance.
*** Investigate with imaging and a punch biopsy of affected skin and possibly core biopsy from deeper masses - if this is negative, doesn't exclude the diagnosis though. May need MRI.
** Idiopathic granulomatous mastitis (IGM)
*** Rare chronic inflammatory breast disease with unclear cause
**** Possibly related to corynebacterium infection
*** Non-caseating granulomas and microabscesses confined to a lobule
*** Painful mass associated with fistulas, abscesses, inflammatory changes
*** No association with smoking
*** Clinical presentation and radiological findings similar to breast cancer
*** Don't excise it - often followed by persistent wound discharge and failure to heal
*** Steroids and immunomodulators have been used, but variable efficacy
*** The condition tends to resolve spontaneously over 6-18 months, so best to treat supportively, especially treating the episodes of infection and abscess formation, through as minimal an intervention as possible