{"id":3743,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastabscess\/"},"modified":"2026-02-10T14:20:52","modified_gmt":"2026-02-10T14:20:52","slug":"breastabscess","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/breastabscess\/","title":{"rendered":"Breast Abscess"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">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. <strong>For those patients where an underlying mass is identified or there are any other signs of Breast Cancer a USC referral should be made. <\/strong><strong><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>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.&nbsp; <\/strong><strong>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.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Disease page<\/a> for all contact details.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please note that the EBU should be contacted as above for patients with an <strong>acute abscess<\/strong>, 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 &#8211; top surgery for gender reassignment, breast augmentation, breast implants or other plastic surgery procedures \u2013 calls should be directed to the on-call Plastic Surgery team at St John\u2019s Hospital in the first instance.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Clinicians should be particularly vigilant when considering a diagnosis of mastitis in older patients (&gt;70) as in this group infection is uncommon, whereas Breast Cancer is common.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Further guidance on treatment failure is provided by <a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fcks.nice.org.uk%2Ftopics%2Fmastitis-breast-abscess%2Fmanagement%2Fmanagement-non-lactating-women%2F%23treatment-failure-recurrence&amp;data=05%7C02%7Cjane.burnett%40nhs.scot%7C3f0f4fe7dcc840b9ca6e08dc9c524210%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638557124306177036%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=UmQU9fdEByHhdkF7UE5DyKnZYv5nUQTe2d7NXuRMe7g%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">CKS &#8211; Clinical Knowledge Summaries from NICE<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><strong>TF, EC, LP &amp; JB FEB 26<\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Urgent Referral<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mastitis or breast inflammation which does not settle after one course of antibiotics (refer as USC)<\/li>\n\n\n\n<li>Obvious abscess within breast tissue (should be discussed immediately with EBU to arrange review within 24 hours)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Routine Referral<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Those with troublesome skin cysts who wish to consider excision<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Who not to refer<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mastitis or breast inflammation <strong>before one course of antibiotics has been tried as per local prescribing guidelines <\/strong>unless there is an immediate concern of an underlying Breast Cancer<\/li>\n\n\n\n<li>Those with skin cysts which are not troublesome<\/li>\n\n\n\n<li>Those with hidradenitis. See guidance under Dermatology for <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dermatology\/hidradentis-suppurativa\/\" target=\"_blank\" rel=\"noreferrer noopener\">Hidradenitis Suppurativa<\/a>.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Edinburgh, Midlothian, and East Lothian Patients<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>For acute abscess call for immediate discussion with EBU<\/li>\n\n\n\n<li>For other referrals refer via SCI Gateway to Western General Hospital:<br>Western General Hospital &gt;&gt; General Surgery \u2013 Breast &gt;&gt; LI Breast \u2013 Non Urgent<br>OR<br>Western General Hospital &gt;&gt; General Surgery \u2013 Breast &gt;&gt; LI Breast \u2013 Urgent<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>West Lothian Patients<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>For acute abscess call for immediate discussion with EBU at the WGH<\/li>\n\n\n\n<li>For other referrals refer via SCI Gateway to St John\u2019s Hospital:<br>St John\u2019s Hospital &gt;&gt; General Surgery \u2013 Breast &gt;&gt; LI Breast \u2013 Non Urgent<br>OR<br>St John\u2019s Hospital &gt;&gt; General Surgery \u2013 Breast &gt;&gt; LI Breast \u2013 UrgentBreast \u2013 Urgent<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">Patients with suspected breast infection should receive immediate, appropriate, oral antibiotics, as per local guidance: <a href=\"https:\/\/formulary.nhs.scot\/east\/infections\/wound-and-skin\/mastitis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Infection on East Formulary<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Sexual-Health-HRT-Further-Info-Incr-Risk-Breast-Ca-MHRADDL_HRT_30.08.19.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">HRT: further information on the known increased risk of BC with HRT and its persistence after stopping MHRA<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.macmillan.org.uk\/cancer-information-and-support\/breast-cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer at MacMillan<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.cancerresearchuk.org\/about-cancer\/breast-cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer at Cancer Research UK<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/breastcancernow.org\/#main-content\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer at Breast Cancer Now<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/scottish-referral-guidelines-for-suspected-cancer\/breast-cancer\/?searchTerm=scottish%20referral%20guidelines%20for%20suspected%20cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer section of Scottish Referral Guidelines for Suspected Cancer on RDS<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3744,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[50],"class_list":["post-3743","page","type-page","status-publish","hentry","category-breastabscessinfection"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/breastdisease\/breastabscessinfection\/\" rel=\"tag\">Breast Abscess and Infection<\/a>","rttpg_excerpt":"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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3743","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3743"}],"version-history":[{"count":19,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3743\/revisions"}],"predecessor-version":[{"id":26728,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3743\/revisions\/26728"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3744"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3743"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3743"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}