Breast cellulitis: Clinical manifestations, diagnosis, and management
- 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
Cellulitis is an uncommon infection in the breast and can be difficult to distinguish from inflammatory breast cancer or benign erythematous conditions of the breast. Pain is a prominent feature of breast cellulitis and is associated with erythema, swelling, and warmth. Inflammatory conditions of the breast not related to cellulitis are reviewed elsewhere. (See "Mastitis and other skin disorders of the breast in adults".)
Cellulitis and erythema of the breast is an uncommon presentation for women seeking medical care for a breast related-problem. For example, a prospective study of 3762 consecutive female patients evaluated in a dedicated breast center found that only 22 women (0.6 percent) presented with erythema of the breast during a 14-month interval, and of those 22, only 2 patients (9 percent) had cellulitis . In comparison, breast cellulitis occurs in approximately 1 to 8 percent of patients managed by breast conservation treatment (partial mastectomy and radiation therapy) [2-7].
Risk factors — Independent risk factors for breast cellulitis include [1-5,7-9]:
- Lactation (see "Lactational mastitis")
- Breast surgery within previous 30 days (surgical site infection) (see "Epidemiology of surgical site infection in adults")
- Prior breast cellulitis or infection
- Trauma (eg, bites, nipple piercing, tattoos)
- Infected skin lesions (eg, eczema, dryness, dermatitis)
- Breast conservation treatment for breast cancer (partial mastectomy and radiation therapy)
Beta-hemolytic streptococcus is an important cause of breast cellulitis [3,9,10]. A case-control study conducted in three metropolitan areas in the United States demonstrated that breast cancer was a risk factor for the development of group B streptococcal infection . Group B beta-hemolytic streptococci have a proclivity to produce soft-tissue infections in the setting of venous and/or lymphatic compromise . Staphylococcus aureus, including methicillin-resistant S. aureus, can also be an important pathogen. (See "Cellulitis and erysipelas" and "Group B streptococcal infections in nonpregnant adults".)
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- Risk factors
- CLINICAL FEATURES
- Patient presentation
- Imaging studies
- - Mammogram
- - Ultrasound
- - Magnetic resonance imaging
- Laboratory findings
- - Laboratory tests
- - Blood cultures
- - Skin aspirate culture
- DIAGNOSTIC EVALUATION
- DIFFERENTIAL DIAGNOSIS
- Benign etiologies
- - Mondor's disease
- - Abscess
- - Postoperative dermal lymphedema
- - Morphea
- - Dermatologic disorders
- Malignant etiologies
- - Inflammatory breast cancer
- - Paget's disease
- Post-radiation treatment etiologies
- - Radiation induced dermatitis
- - Radiation induced fibrosis
- Guiding principles
- Recurrent cellulitis
- SUMMARY AND RECOMMENDATIONS