Breast cellulitis and other skin disorders of the breast
- J Michael Dixon, MD
J Michael Dixon, MD
- Professor of Surgery and Consultant Surgeon
- Edinburgh University
- Larry M Baddour, MD, FIDSA
Larry M Baddour, MD, FIDSA
- Professor of Medicine
- Mayo Clinic College of Medicine
- Section Editors
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Breast cellulitis is a skin infection that occurs as a result of bacterial entry via breaches in the skin barrier. Issues related to breast cellulitis and other skin disorders of the breast will be reviewed here. Issues related to breast abscess and lactational mastitis are discussed separately. (See "Primary breast abscess" and "Lactational mastitis".)
Epidemiology — Breast cellulitis is relatively uncommon. A prospective study including 3762 patients evaluated in a dedicated breast center during a 14-month interval found that 0.6 percent presented with erythema of the breast and, of those 22 patients, only 2 had cellulitis . Among patients managed for breast cancer with partial mastectomy and radiation therapy, breast cellulitis occurs in 1 to 8 percent of patients [2-7].
Risk factors for breast cellulitis include [1-5,7-9]:
●Breast conservation treatment for breast cancer (breast conserving surgery and radiation therapy)
●Prior breast cellulitis or infection
- Froman J, Landercasper J, Ellis R, et al. Red breast as a presenting complaint at a breast center: an institutional review. Surgery 2011; 149:813.
- Hughes LL, Styblo TM, Thoms WW, et al. Cellulitis of the breast as a complication of breast-conserving surgery and irradiation. Am J Clin Oncol 1997; 20:338.
- Mertz KR, Baddour LM, Bell JL, Gwin JL. Breast cellulitis following breast conservation therapy: a novel complication of medical progress. Clin Infect Dis 1998; 26:481.
- Indelicato DJ, Grobmyer SR, Newlin H, et al. Delayed breast cellulitis: an evolving complication of breast conservation. Int J Radiat Oncol Biol Phys 2006; 66:1339.
- Brewer VH, Hahn KA, Rohrbach BW, et al. Risk factor analysis for breast cellulitis complicating breast conservation therapy. Clin Infect Dis 2000; 31:654.
- Zippel D, Siegelmann-Danieli N, Ayalon S, et al. Delayed breast cellulitis following breast conserving operation. Eur J Surg Oncol 2003; 29:327.
- Baddour LM. Breast cellulitis complicating breast conservation therapy. J Intern Med 1999; 245:5.
- Miller SR, Mondry T, Reed JS, et al. Delayed cellulitis associated with conservative therapy for breast cancer. J Surg Oncol 1998; 67:242.
- Rescigno J, McCormick B, Brown AE, Myskowski PL. Breast cellulitis after conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys 1994; 29:163.
- Simon MS, Cody RL. Cellulitis after axillary lymph node dissection for carcinoma of the breast. Am J Med 1992; 93:543.
- Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association with venous and lymphatic compromise. Am J Med 1985; 79:155.
- Jackson LA, Hilsdon R, Farley MM, et al. Risk factors for group B streptococcal disease in adults. Ann Intern Med 1995; 123:415.
- Peltecu G. Images in clinical medicine. Cellulitis after treatment for breast cancer. N Engl J Med 2007; 357:488.
- Staren ED, Klepac S, Smith AP, et al. The dilemma of delayed cellulitis after breast conservation therapy. Arch Surg 1996; 131:651.
- Dixon JM. Breast infection. In: ABC of Breast Diseases, Dixon JM (Ed), Blackwell Publishing, Oxford 2006. p.19.
- Foxman B, D'Arcy H, Gillespie B, et al. Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol 2002; 155:103.
- Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects. Obstet Gynecol 2007; 109:479.
- Stafford I, Hernandez J, Laibl V, et al. Community-acquired methicillin-resistant Staphylococcus aureus among patients with puerperal mastitis requiring hospitalization. Obstet Gynecol 2008; 112:533.
- Jahanfar S, Ng CJ, Teng CL. Antibiotics for mastitis in breastfeeding women. Cochrane Database Syst Rev 2009; :CD005458.
- Hale TW, Berens PD. Clinical Therapy in Breastfeeding Patients, 2nd ed, Pharmasoft, Amarillo 2002.
- Peters F, Petersen EE, Kirkpatrick CJ. Isolated erythema (cellulitis) of the breast. Breast 2002; 11:484.
- Rahmouni A, Chosidow O, Mathieu D, et al. MR imaging in acute infectious cellulitis. Radiology 1994; 192:493.
- Vitug AF, Newman LA. Complications in breast surgery. Surg Clin North Am 2007; 87:431.
- Throckmorton AD, Boughey JC, Boostrom SY, et al. Postoperative prophylactic antibiotics and surgical site infection rates in breast surgery patients. Ann Surg Oncol 2009; 16:2464.
- McNeely ML, Binkley JM, Pusic AL, et al. A prospective model of care for breast cancer rehabilitation: postoperative and postreconstructive issues. Cancer 2012; 118:2226.
- Dixon JM, Bundred NJ. Management of disorders of the ductal system and infections. In: Diseases of the Breast, Harris JR, Lippman ME, Morrow M, Osborne CK (Eds), Lippincott Williams & Wilkins, Philadelphia 2004. p.47.
- Becker L, McCurdy LI, Taves DH. Superficial thrombophlebitis of the breast (Mondor's disease). Can Assoc Radiol J 2001; 52:193.
- Milgrom S, Higgins SA. Management of cellulitis associated with treatment of breast cancer. J Support Oncol 2009; 7:174.
- Catania S, Zurrida S, Veronesi P, et al. Mondor's disease and breast cancer. Cancer 1992; 69:2267.
- Shetty MK, Watson AB. Mondor's disease of the breast: sonographic and mammographic findings. AJR Am J Roentgenol 2001; 177:893.
- Yanik B, Conkbayir I, Oner O, Hekimoğlu B. Imaging findings in Mondor's disease. J Clin Ultrasound 2003; 31:103.
- Pasta V, D'Orazi V, Sottile D, et al. Breast Mondor's disease: Diagnosis and management of six new cases of this underestimated pathology. Phlebology 2015; 30:564.
- Laroche JP, Galanaud J, Labau D, et al. Mondor's disease: what's new since 1939? Thromb Res 2012; 130 Suppl 1:S56.
- Clark CJ, Wechter D. Morphea of the breast--an uncommon cause of breast erythema. Am J Surg 2010; 200:173.
- Dubner S, Bovi J, White J, Susnik B. Postirradiation morphea in a breast cancer patient. Breast J 2006; 12:173.
- King R, Duncan L, Shupp DL, Googe PB. Postsurgical dermal lymphedema clinically mimicking inflammatory breast carcinoma. Arch Dermatol 2001; 137:969.
- Browse NL, Stewart G. Lymphoedema: pathophysiology and classification. J Cardiovasc Surg (Torino) 1985; 26:91.
- Marcks P. Lymphedema. Pathogenesis, prevention, and treatment. Cancer Pract 1997; 5:32.
- Bauer KA. Coumarin-induced skin necrosis. Arch Dermatol 1993; 129:766.
- Dixon JM, Khan LR. Treatment of breast infection. BMJ 2011; 342:d396.
- Attar KH, Waghorn D, Lyons M, Cunnick G. Rare species of actinomyces as causative pathogens in breast abscess. Breast J 2007; 13:501.
- Dixon JM. Breast abscess. Br J Hosp Med (Lond) 2007; 68:315.
- Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol 2009; 60:539.
- Buimer MG, Wobbes T, Klinkenbijl JH. Hidradenitis suppurativa. Br J Surg 2009; 96:350.
- Janniger CK, Schwartz RA, Szepietowski JC, Reich A. Intertrigo and common secondary skin infections. Am Fam Physician 2005; 72:833.
- Mistiaen P, Poot E, Hickox S, et al. Preventing and treating intertrigo in the large skin folds of adults: a literature overview. Dermatol Nurs 2004; 16:43.
- Gannon MX, Crowson MC, Fielding JW. Periareolar pilonidal abscesses in a hairdresser. BMJ 1988; 297:1641.
- Banerjee A. Pilonidal sinus of nipple in a canine beautician. BMJ 1985; 291:1787.
- Bowers PW. Roustabouts' and barbers' breast. Clin Exp Dermatol 1982; 7:445.
- Dixon JM. Benign breast disease. In: The New Airds Companion to Surgical Studies, Burnand KG, Young AE (Eds), Churchill Livingstone, Edinburgh 1992. p.811.
- Gollapalli V, Liao J, Dudakovic A, et al. Risk factors for development and recurrence of primary breast abscesses. J Am Coll Surg 2010; 211:41.