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Abstract: Patient Ms. Huang, 32 years old, came to the clinic with “swelling and pain in the left breast” one week ago, and was considered to have left-sided mastitis with abscess formation based on her medical history and relevant examinations. After the surgery, the patient’s pus was drained out and the inflammation gradually subsided after daily incisional irrigation and drug changes, and the mastitis was cured.
Basic information】Female, 32 years old
Disease Type】Left-sided mastitis with abscess formation
Hospital】The First Hospital of Harbin Medical University
Date of consultation】March 2022
Treatment plan】Medication (cefradine for injection) + surgery (mammary abscess incision and drainage)
Treatment period】8 days of hospitalization
Effectiveness】Effectively relieved the patient’s breast pain and improved the patient’s quality of life
I. Initial consultation
Patient Ms. Huang, who was breastfeeding, came to our hospital in March 2022. She reported swelling and pain in her left breast 1 week ago. On closer examination: localized redness and swelling with pain and discomfort, no nipple overflow. The patient’s mammogram showed that a hypoechoic area of approximately 7.5 cm (over the nipple perpendicular to the axilla) × 5.6 cm × 3.2 cm (deep diameter) was visible in the left breast from clockwise at 11 o’clock to clockwise at 5 o’clock and around the areola, with irregular contours and filled with weak dot-like echogenic floating in a dumbbell shape, continuing into the surrounding tissue space. In the lower quadrant of the left breast, there were more milk duct echoes with a width of 0.24 cm and average transmission, extending toward the nipple and connecting to the abscess. The mammogram showed that the thickened skin of the left lateral breast accumulated in the areola area, the subcutaneous fat layer was cloudy, and an irregular isointense mass of about 37 mm×25 mm was seen above the left breast with unclear boundaries, and irregular isointense nodules of 11 mm×9 mm and 4 mm×5 mm were seen next to it. Combined with the patient’s medical history and relevant examinations, the patient was considered to have left-sided mastitis with abscess formation.
II. Treatment history
Based on the patient’s condition, surgical treatment was considered based on the application of cefradine for injection to counteract the infection, with the aim of completely draining the pus from the abscess cavity and removing the necrotic tissue. After the patient was hospitalized and the necessary preoperative examinations were completed, full communication was made with the patient and her husband, and the purpose and procedure of the surgery were explained in detail, and the patient expressed her understanding and active cooperation with the treatment. The patient then underwent an incision and drainage of the left breast abscess. After the operation, the incision was changed and cared for.
III. Treatment effect
After the application of cefradin for injection combined with incision and drainage of breast abscess, the pus was thoroughly drained and necrotic tissue was removed. The breast inflammation subsided, the patient’s breast pain gradually disappeared, and the quality of life improved significantly. After 8 days of hospitalization, the patient gradually recovered, no redness, swelling and infection in the incision, good mental state and no other abnormal symptoms, and the patient felt well recovered and was discharged from the hospital.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but we need to pay attention to the following matters in daily life.
1. breastfeeding habits: the patient in this case is in breastfeeding period, in order to avoid the recurrence of such events, the patient should avoid milk stagnation, prevent nipple injury and keep it clean.
2. incision care: In this case, the patient had abscess formation and a large abscess cavity, which required long-term incisional flushing and dressing changes until the incision healed. Each time the dressing is changed, the condition of the incision needs to be evaluated for early detection of abnormalities.
3. Monitoring of blood sugar: In this case, the patient’s blood sugar was elevated in the preoperative examination, and strict monitoring and control of blood sugar is required after surgery. Poor blood glucose control can lead to slower healing of the incision and even infection. Patients can consult the endocrinology department and follow the doctor’s advice to choose the appropriate plan to adjust blood sugar, such as diet control, appropriate exercise, application of hypoglycemic drugs or insulin, etc.
V. Personal insight
Mastitis is an acute purulent infection of the mammary glands and is most commonly seen in women who are breastfeeding after childbirth, especially in the 3-4 week postpartum period. If there is redness, swelling and pain in the breast, the patient should undergo standardized and systematic treatment in a regular hospital. Incomplete and unregulated treatment can lead to recurrent mastitis, doubling the patient’s pain. In the early stages of inflammation, before abscesses are formed, antibiotic treatment is the first choice. However, in this case, the patient had already formed a breast abscess, and simple antibiotic treatment was not sufficient. Surgery was needed to remove necrotic tissue and drain the pus, so that the inflammation would gradually subside and finally the disease would be cured.