What criteria should I use to decide whether to refer a patient with mastitis for surgical intervention?

Criteria for referral of a patient with mastitis for surgical intervention include:

• Suspected breast abscess: Refer urgently to a general surgeon if a breast abscess is suspected, as antibiotics alone without pus removal are unlikely to be curative.
• Signs of sepsis: Arrange hospital admission if there are systemic signs such as tachycardia, fever, chills, or if the infection progresses rapidly.
• Haemodynamic instability or immunocompromise: These conditions warrant hospital admission and specialist management.
• Underlying mass or suspicion of breast cancer: Arrange an urgent 2-week wait referral if breast cancer is suspected or an underlying mass is present.
• Use of ultrasound: Even if clinical examination suggests an abscess, ultrasound is recommended to identify multiple pus collections that may require surgical drainage.

In summary, surgical referral is primarily indicated for suspected breast abscesses requiring drainage, systemic infection signs, or suspicion of malignancy.

Additional management advice: If immediate referral is not indicated, reassure the patient, prescribe analgesics, advise cold compresses, and encourage continuation of breastfeeding if applicable.

NICE CKS,NICE CKS