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 USOC referral should be made.
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.
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 whose infections do not settle within one week, after one course of antibiotics, should be referred to the Edinburgh Breast Unit (EBU) as a USOC referral.
Further guidance on treatment failure is provided by CKS.
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, by asking for the on call Breast Surgeon.
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.
J.B & M.B, LP 17-07-24
Who to refer:
Urgent Referral:
- Mastitis or breast inflammation which does not settle after one course of antibiotics (refer as USOC)
- 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 as been tried as per local prescribing guidelines
- 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 – Urgent
Patients with suspected breast infection should receive immediate, appropriate, oral antibiotics, as per local guidance: Breast Infection on East Formulary
