Patients presenting with possible mastitis should be examined, to rule out other signs and symptoms, including skin changes or lumps that the patient may not have identified. For those patients where an underlying mass is identified or there are any other signs of Breast Cancer a USC referral should be made.
Patients should be advised that if symptoms worsen or fail to improve within 48 hours, they should seek review, and clinicians should consider reassessment or referral. All patients with mastitis or breast inflammation that does not settle or recurs after one course of antibiotics, should be referred to the Edinburgh Breast Unit (EBU) with USC priority.
Any patients presenting with an acute abscess require immediate discussion with the EBU. Patients will be seen within 24 hours. The EBU team can be contacted through the switchboard at WGH, see the Breast Disease page for all contact details.
Please note that the EBU should be contacted as above for patients with an acute abscess, should also be contacted if patients present to primary care with acute infection related to recent Breast Cancer surgery. Patients with difficulties related to infection / collections related to one or other of the following – top surgery for gender reassignment, breast augmentation, breast implants or other plastic surgery procedures – calls should be directed to the on-call Plastic Surgery team at St John’s Hospital in the first instance.
Clinicians should be particularly vigilant when considering a diagnosis of mastitis in older patients (>70) as in this group infection is uncommon, whereas Breast Cancer is common.
Health Visitors and Nurse Feeding Counsellors should ensure that any patients who have problems with continued pain and infection are examined promptly by an appropriate doctor and referred urgently if the doctor feels it is appropriate.
Further guidance on treatment failure is provided by CKS – Clinical Knowledge Summaries from NICE.
TF, EC, LP & JB FEB 26
Who to refer
Urgent Referral
- Mastitis or breast inflammation which does not settle after one course of antibiotics (refer as USC)
- Obvious abscess within breast tissue (should be discussed immediately with EBU to arrange review within 24 hours)
Routine Referral
- Those with troublesome skin cysts who wish to consider excision
Who not to refer
- Mastitis or breast inflammation before one course of antibiotics has been tried as per local prescribing guidelines unless there is an immediate concern of an underlying Breast Cancer
- Those with skin cysts which are not troublesome
- Those with hidradenitis. See guidance under Dermatology for Hidradenitis Suppurativa.
How to refer
Edinburgh, Midlothian, and East Lothian Patients
- For acute abscess call for immediate discussion with EBU
- For other referrals refer via SCI Gateway to Western General Hospital:
Western General Hospital >> General Surgery – Breast >> LI Breast – Non Urgent
OR
Western General Hospital >> General Surgery – Breast >> LI Breast – Urgent
West Lothian Patients
- For acute abscess call for immediate discussion with EBU at the WGH
- For other referrals refer via SCI Gateway to St John’s Hospital:
St John’s Hospital >> General Surgery – Breast >> LI Breast – Non Urgent
OR
St John’s Hospital >> General Surgery – Breast >> LI Breast – UrgentBreast – Urgent
Patients with suspected breast infection should receive immediate, appropriate, oral antibiotics, as per local guidance: Breast Infection on East Formulary
