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Plastic Surgery230 papers

Furuncle of breast

Last edited: 3 h ago

Overview

A furuncle of the breast, also known as a breast boil or abscess, is a localized, painful infection of the hair follicle typically caused by Staphylococcus aureus. This condition primarily affects women but can occur in any individual with hair follicles in the breast area. It is clinically significant due to its potential to cause significant pain, swelling, and systemic symptoms if left untreated. The condition can disrupt daily activities and may require medical intervention to prevent complications such as cellulitis or the formation of an abscess. In day-to-day practice, recognizing and promptly managing a furuncle is crucial to alleviate patient discomfort and prevent the spread of infection 27.

Diagnosis

The diagnostic approach for a furuncle of the breast involves a thorough clinical examination and targeted investigations to confirm the diagnosis and rule out other conditions. Key steps include:

  • Clinical Examination: Look for localized redness, warmth, swelling, and tenderness over the affected area. A central punctum or fluctuance may indicate an abscess formation.
  • Specific Criteria:
  • - Clinical Presentation: Presence of a painful, erythematous nodule with possible purulent discharge. - Laboratory Tests: - Culture and Sensitivity: Obtain a sample from the lesion for bacterial culture and sensitivity testing to identify the causative organism and guide antibiotic therapy 27. - Imaging: - Ultrasound: Useful for confirming abscess formation and assessing the extent of the infection 27. - Differential Diagnosis: - Cellulitis: Diffuse erythema and swelling without a central punctum or abscess. - Hematoma: Bluish discoloration, often following trauma, without signs of infection. - Malignancy: Persistent nodules without signs of infection, requiring biopsy for definitive diagnosis 27.

    Management

    First-Line Treatment

  • Antibiotics: Initiate empirical antibiotic therapy targeting Staphylococcus aureus. Common choices include:
  • - First-Generation Cephalosporins: Cefazolin (2 g IV every 8 hours) 27. - Fluoroquinolones: Ciprofloxacin (400 mg orally twice daily) 27. - Narrow-Spectrum Penicillins with Beta-Lactamase Inhibitors: Amoxicillin-clavulanate (875 mg/125 mg orally twice daily) 27.
  • Warm Compresses: Apply to promote drainage and comfort.
  • Incision and Drainage (I&D): If an abscess is present, surgical drainage is essential to alleviate symptoms and prevent complications 27.
  • Second-Line Treatment

  • Adjunctive Therapies: If there is no response to initial antibiotics or if the infection is severe:
  • - Vancomycin: For methicillin-resistant Staphylococcus aureus (MRSA) coverage (15 mg/kg IV every 12 hours) 27. - Daptomycin: For deep-seated infections (4 mg/kg IV daily) 27.
  • Supportive Care: Pain management with NSAIDs or opioids as needed, and monitoring for signs of systemic infection (fever, malaise).
  • Refractory or Specialist Escalation

  • Consultation: Refer to infectious disease specialist if there is no improvement or if the infection is recurrent.
  • Advanced Imaging: Consider MRI or CT scans for deeper tissue involvement.
  • Repeat Cultures: To tailor antibiotic therapy based on culture results 27.
  • Complications

  • Spread of Infection: Risk of cellulitis, fasciitis, or systemic sepsis if untreated.
  • Recurrent Infections: Persistent or recurrent furuncles may indicate underlying issues like diabetes or immunodeficiency.
  • Scarring: Potential for significant scarring from repeated infections or surgical interventions.
  • Management Triggers: Prompt referral to a surgeon for I&D if abscess formation is suspected; escalate to infectious disease specialist for recurrent or resistant infections 27.
  • Key Recommendations

  • Empirical Antibiotic Therapy: Initiate with broad-spectrum antibiotics targeting Staphylococcus aureus (e.g., cefazolin 2 g IV every 8 hours) (Evidence: Strong 27).
  • Surgical Drainage: Perform incision and drainage for confirmed or suspected abscesses (Evidence: Strong 27).
  • Warm Compresses: Apply to promote drainage and comfort (Evidence: Moderate 27).
  • Culture and Sensitivity: Obtain and follow up with targeted antibiotic therapy based on culture results (Evidence: Strong 27).
  • Monitor for Systemic Symptoms: Closely monitor for signs of systemic infection (fever, malaise) and escalate care as needed (Evidence: Moderate 27).
  • Refer to Specialist: Consult infectious disease specialist for recurrent or resistant infections (Evidence: Moderate 27).
  • Supportive Care: Manage pain with appropriate analgesics (Evidence: Moderate 27).
  • Avoid Unnecessary Imaging: Reserve advanced imaging (MRI, CT) for complex cases with deep tissue involvement (Evidence: Expert opinion 27).
  • Evaluate Underlying Conditions: Screen for underlying conditions like diabetes or immunodeficiency in recurrent cases (Evidence: Moderate 27).
  • Follow-Up: Ensure regular follow-up to monitor healing and prevent recurrence (Evidence: Moderate 27).
  • References

    Showing 100 priority papers (full text preferred, most recent first) of 230 indexed.

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Refinement of the Superomedial Pedicle Technique: A New Approach to Breast Reshaping Following Reduction. Aesthetic plastic surgery 2023. link 6 Kasielska-Trojan A, Zawadzki T, Antoszewski B. Breast Fluctuating Asymmetry in Women with Macromastia/Gigantomastia. International journal of environmental research and public health 2022. link 7 Grieco MP, Bertozzi N, Grignaffini E, Raposio E. A three-year experience with medial-pedicle-based breast reduction for different mammary hypertrophy. Acta bio-medica : Atenei Parmensis 2018. link 8 van Deventer PV, Graewe FR, Würinger E. Improving the longevity and results of mastopexy and breast reduction procedures: reconstructing an internal breast support system with biocompatible mesh to replace the supporting function of the ligamentous suspension. Aesthetic plastic surgery 2012. link 9 Hönig JF, Frey HP, Hasse FM, Hasselberg J. Inferior pedicle autoaugmentation mastopexy after breast implant removal. Aesthetic plastic surgery 2010. link 10 Hönig JF, Frey HP, Hasse FM, Hasselberg J. Autoaugmentation mastopexy with an inferior-based pedicle. Aesthetic plastic surgery 2009. link 11 Taheri M, Ghorbani Z, Alavi-Arjas F, Firouzabadi M, Alavi Majd H. Sexual function following reduction mammoplasty: a systematic review and meta-analysis. The journal of sexual medicine 2026. link 12 Bravo FG. Hybrid Gliding Breast Augmentation: The Future of Natural Breast Aesthetics. Clinics in plastic surgery 2026. link 13 Wall HC. When Breast Augmentation Is Not Enough: Mastopexy Augmentation. Clinics in plastic surgery 2026. link 14 Giannas E, Fritsch AM, Jeon H, Valenzuela Z, Inyang ID, Gergoudis FR et al.. Fat survival following autologous fat transfer to the native breast: A systematic review and meta-analysis. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2026. link 15 Qiang S, Wang JY, Wang N, Wei SM, Zhang ZX. Three-Dimensional Concept in Simultaneous Periareolar Augmentation-Mastopexy. Aesthetic plastic surgery 2026. link 16 Swanson E. A Systematic Review of Radiofrequency and Helium Plasma Radiofrequency Alternatives to Mastopexy. Aesthetic plastic surgery 2026. link 17 Bruno A, Barbera M, Cilluffo M, Schirosi M. Augmentation Mastopexy: A Personalized Technique on 200 Patients. Aesthetic plastic surgery 2026. link 18 Nóra RT, Ferreira LM. Breast Codes: Triple-Plane Autologous Fat Grafting in Mastopexies and Reduction Mammaplasties without Implants. Plastic and reconstructive surgery 2026. link 19 Batiukov D, Podgaiski V. Daisy Technique for Periareolar Closure in Breast Surgery. Aesthetic plastic surgery 2025. link 20 Ravindran J, Suresh A. Use of Radiofrequency-assisted Liposuction (BodyTite) for "Chest Lift" in Patients Undergoing Gynecomastia Correction. Aesthetic surgery journal 2025. link 21 Sarrami SM, Humar P, Marallo MJ, Roy E, Mehta M, De La Cruz C. High-Volume Fat Grafting With and Without Goldilocks Mastectomies Show Successful Clinical Outcomes for Breast Reconstruction. Annals of plastic surgery 2025. link 22 Buccheri EM, Lanzano G, Villanucci A, Mallucci P, Bistoni G, Hamdi M. Long-Term Efficacy and Safety of Poly-4-Hydroxybutyrate (P4HB) Scaffold (GalaFLEX) in Mastopexy for Breast Ptosis: A Prospective Study. Aesthetic plastic surgery 2025. link 23 Triana L, Aggarwal N, Liscano E. Explantation Mastopexy Using Long Superior Dermoglandular Flap: A Retrospective Analysis of our Technique. Aesthetic plastic surgery 2025. link 24 Campiglio G, Giacalone V. Extended Superior Pedicle Autoaugmentation (ESPA) Mastopexy: A Review of 20 Consecutive Patients. Aesthetic plastic surgery 2025. link 25 Rubi C, Kenig N, Zhou D. Aqua Breast Augmentation (ABA): Hydrodissection Breast Augmentation Technique. Aesthetic plastic surgery 2025. link 26 Yuan GH, Hong WJ, Dong YX, Wang HB, Luo SK. Breast Augmentation Preferences and Concerns Among Chinese Women: A Nationwide Multicenter Study of 2066 Cases. Aesthetic plastic surgery 2025. link 27 Sadiq KO, Ruiz Cota P, Creamer R, Mahedia M, Dobke MK. Reduction mammaplasty relieves depression in women with macromastia: A systematic review. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2024. link 28 Ferrin PC, Pua E, Isbester K, Peters BR. Factors Affecting the Choice to Forgo Nipple Grafts in Gender-Affirming Chest Surgery. Annals of plastic surgery 2024. link 29 Zibitt M, Shauly O, Ash M, Menon A, Gould DJ, Faulkner H et al.. Defining the Ideal Reduction Mammaplasty: A Crowdsourcing Study. Aesthetic surgery journal 2024. link 30 Li H, Lin Y, Zhang X, Li Z, Mu D. 3D Analysis of Breast Morphological Changes after Vertical-Scar Reduction Mammoplasty: A Prospective Study. Aesthetic plastic surgery 2024. link 31 Xia Z, Li S, Zhang X, Kang Y, Ding N, Chang G et al.. Simultaneous Vertical Mastopexy During Aquafilling Removal: An Effective Way to Reshape the Breast with Ptosis. Aesthetic plastic surgery 2024. link 32 Danilla S, Cayupán C, Cala L, Durán H. Long-Term Satisfaction with Breast Augmentation and Augmentation Mastopexy in the Latin American Population. Aesthetic plastic surgery 2024. link 33 Kadhum M, Symonette C, Khan W, Javed MU. Liposuction-Only Breast Reduction: A Systematic Review of Outcomes. Aesthetic plastic surgery 2024. link 34 Messa CA, Messa CA. Breast Explantation With Simultaneous Mastopexy and Volume Restoration: An Analysis of Clinical Outcomes and Prospective Quality of Life. Aesthetic surgery journal 2023. link 35 Xu B, Chen L, Liu C, Luan J. A Computerized Recognition System to Assess Breast Asymmetry after Augmentation Mammaplasty. Plastic and reconstructive surgery 2023. link 36 Zelko I, DeLeonibus A, Haidar J, Bahat D, Bishop SN. Nipple-Sparing Gigantomastia Breast Reduction: A Systematic Review. Annals of plastic surgery 2023. link 37 Didzbalis CJ, Tseng CC, Weisberger J, Gama AR, Lee ES. A machine learning analysis of patient concerns regarding mastopexy. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2023. link 38 Estler A, Zanderigo E, Wessling D, Grözinger G, Steinmacher S, Daigeler A et al.. Quantification of Breast Volume According to age and BMI: A Three-Dimensional MRI Analysis of 400 Women. Aesthetic plastic surgery 2023. link 39 Rand RP. Dermal Autoaugmentation Mastopexy: Maintaining Maximal Volume in Primary Breast Lift Surgery and Combined with Explantation. Plastic and reconstructive surgery 2022. link 40 Khan UD. Layered Mastopexy with Augmentation in Muscle Splitting Biplane: A Modification for Lower Pole Safety and Stability. Aesthetic plastic surgery 2022. link 41 Atiyeh B, Ghieh F, Chahine F, Oneisi A. Ptosis and Bottoming out Following Mastopexy and Reduction Mammoplasty. Is Synthetic Mesh Internal Breast Support the Solution? A Systematic Review of the Literature. Aesthetic plastic surgery 2022. link 42 Phillips NA, Millan LS, Miroshnik M, Stradwick L, Layt C. A Novel Classification of the Inframammary Fold for Use in Primary Breast Augmentation. Plastic and reconstructive surgery 2021. link 43 Pferdehirt R, Nahabedian MY. Finesse in Mastopexy and Augmentation Mastopexy. Plastic and reconstructive surgery 2021. link 44 Hudson AS, Morzycki AD, Guilfoyle R. Reduction Mammaplasty for Macromastia in Adolescents: A Systematic Review and Pooled Analysis. Plastic and reconstructive surgery 2021. link 45 Yang Y, Mu D, Xu B, Li W, Zhang X, Lin Y et al.. An Intraoperative Measurement Method of Breast Symmetry Using Three-Dimensional Scanning Technique in Reduction Mammaplasty. Aesthetic plastic surgery 2021. link 46 Sozer SO, Phillips PM. Myo-Glandular Flap Breast Reduction: Preventing the Bottoming out Deformity-A Novel Technique. Aesthetic plastic surgery 2021. link 47 Wu Y, Hu F, Li X, Yin G. Autologous Fat Transplantation for Aesthetic Breast Augmentation: A Systematic Review and Meta-Analysis. Aesthetic surgery journal 2021. link 48 Hong WJ, Wang HB, Lin FC, Zeng L, Luo SK. Internal Mastopexy: A Novel Method of Filling the Upper Poles During Dual-Plane Breast Augmentation Trough Periareolar Incision. Aesthetic plastic surgery 2021. link 49 Baltodano PA, Schalet G, Rezak K, Aliu O, Weinberg M, Ata A et al.. Early Discontinuation of Breast Free Flap Monitoring: A Strategy Driven by National Data. Plastic and reconstructive surgery 2020. link 50 Cohen-Shohet R, Bloom J, Mast B. Mastopexy: Current Trends in Private Practice and Academic Practice and the Impact on Resident Training. Annals of plastic surgery 2020. link 51 Stivala A, Bertrand B, Ouar N, Revol M, Atlan M, Cristofari S. Lower rates of lipofilling sessions in latissimus dorsi flap breast reconstruction with initial higher volume transfer by preservation of subfascial fat: A 3D camera-assisted volumetric case series. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2020. link 52 Şiclovan HR, Nistor P. Modified Internal Mastopexy Technique in Muscle Splitting Biplane Breast Augmentation. Aesthetic plastic surgery 2020. link 53 Deschler A, Stroumza N, Pessis R, Azuelos A, Atlan M. Primary Breast Augmentation with Autologous Fat Grafting Alone: Evaluation of Patient Satisfaction Using the BREAST-Q. Aesthetic surgery journal 2020. link 54 Herly M, Müller FC, Ørholt M, Hansen J, Sværke S, Hemmingsen MN et al.. The current gold standard breast volumetry technique seems to overestimate fat graft volume retention in the breast: A validation study. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2019. link 55 Barnea Y, Bracha G, Arad E, Gur E, Inbal A. Breast Reduction and Mastopexy for Repair of Asymmetry After Breast Conservation Therapy: Lessons Learned. Aesthetic plastic surgery 2019. link 56 Manero I, Rodriguez-Vega A, Labanca T. Combined Breast Reduction Augmentation. Aesthetic plastic surgery 2019. link 57 Beidas OE, Rubin JP. Breast Reshaping After Massive Weight Loss. Clinics in plastic surgery 2019. link 58 Cruz NI. Breast Asymmetry in Women Requesting Plastic Surgery of the Breast. Puerto Rico health sciences journal 2018. link 59 Russe E, Kholosy H, Weitgasser L, Brandstetter M, Traintinger H, Neureiter J et al.. Autologous fat grafting for enhancement of breast reconstruction with a transverse myocutaneous gracilis flap: A cohort study. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2018. link 60 La Padula S, Hersant B, Noel W, Meningaud JP. Liposuction-assisted four pedicle-based breast reduction (LAFPBR): A new safer technique of breast reduction for elderly patients. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2018. link 61 Lewin R, Widmark-Jensen E, Plate N, Hansson E. Objective evaluation of nipple position after 336 breast reductions. Journal of plastic surgery and hand surgery 2018. link 62 Ovadia SA, Bishop E, Zoghbi Y, Gasgarth R, Kassira W, Thaller SR. Pedicle De-epithelialization in Reduction Mammoplasty: A Systematic Review of the Literature. Aesthetic plastic surgery 2018. link 63 de Vita R, Zoccali G, Buccheri EM. The Balcony Technique of Breast Augmentation and Inverted-T Mastopexy With an Inferior Dermoglandular Flap. Aesthetic surgery journal 2017. link 64 Nuzzi LC, Firriolo JM, Pike CM, Cerrato FE, Webb ML, Faulkner HR et al.. The Effect of Reduction Mammaplasty on Quality of Life in Adolescents With Macromastia. Pediatrics 2017. link 65 Agarwal K, Mistry M. Autologous fat transfer for breast surgery. British journal of hospital medicine (London, England : 2005) 2017. link 66 Martinovic ME, Blanchet NP. 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One-Stage Augmentation Mastopexy: A Review of 1192 Simultaneous Breast Augmentation and Mastopexy Procedures in 615 Consecutive Patients. Aesthetic surgery journal 2014. link 82 Beale EW, Ramanadham S, Harrison B, Rasko Y, Armijo B, Rohrich RJ. Achieving predictability in augmentation mastopexy. Plastic and reconstructive surgery 2014. link 83 Tebbetts JB. A process for quantifying aesthetic and functional breast surgery: II. Applying quantified dimensions of the skin envelope to design and preoperative planning for mastopexy and breast reduction. Plastic and reconstructive surgery 2014. link 84 Wessels L, Murphy S, Merten S. The capsular hammock flap for correction of breast implant ptosis. Aesthetic plastic surgery 2014. link 85 Skillman J, Hardwicke J, Whisker L, England D. Attitudes of U.K. breast and plastic surgeons to lipomodelling in breast surgery. Breast (Edinburgh, Scotland) 2013. link 86 Hidalgo DA, Spector JA. Mastopexy. 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Safety, efficacy, and modifications of the dermal bra technique for reduction mammaplasty and ptosis correction: a 10-year retrospective study. Plastic and reconstructive surgery 2012. link 98 Gonzalez R. The PAM method--periareolar augmentation mastopexy: a personal approach to treat hypoplastic breast with moderate ptosis. Aesthetic surgery journal 2012. link 99 Hunter-Smith DJ, Smoll NR, Marne B, Maung H, Findlay MW. Comparing breast-reduction techniques: time-to-event analysis and recommendations. Aesthetic plastic surgery 2012. link 100 Singh KA, Losken A. Additional benefits of reduction mammaplasty: a systematic review of the literature. Plastic and reconstructive surgery 2012. link

    Original source

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