breast cellulitis

Breast cellulitis is a complication which can arise following breast conserving surgery or radiation therapy for breast cancer. Cellulitis is an acute, spreading 'pyogenic' (producing pus) inflammation, usually of the dermis and subcutaneous tissue, and can occur anywhere there is a wound to the skin, but may also occur in the breast following breast cancer treatments. Essentially, it is an inflammatory reaction to an infection, which can cause build-ups of fluid (edema), warmth, tenderness and pain, swelling, rash, and redness (erythema) to the breast. Breast cellulitis is similar to breast abscess, but has a greater tendency to spread around under the skin and not pool into one pocket like an abscess. It is often associated with fever and toxicity due to the involvement of the lymphatic system. Some women may also experience relentless chills, and leukocytosis (raised white blood cell count).

 

breast cellulitis

 

breast cellulitis is usually caused by an opportunistic infection

Even though the condition is caused by an opportunistic infection, it is believed that the 'stasis' of movement of fluid through lymphatic channels might provide an opportunity for bacterial growth. 'Microtrauma' (exteremly small tears in the skin) may also precipitate breast cellulitis. There is also growing support of the idea that breast cancer patients who have experienced post-treatment seroma of the breast might also be predisposed to breast cellulitis. Unlike seroma or breast abscess, breast cellulitis will typically not develop any kind of palpable mass, or suspicious breast changes present on mammographic images.

Frequency of delayed post-treatment breast cellulitis

Breast cellulitis does not always develop immediately after of during radiation treatments, but can actually develop weeks or even months later. For this reason it is often termed 'delayed-onset' breast cellulitis (DBS). The number of breast cancer patients who will likely experience breast cellultis is not that high, ranging from 5-8% according to some estimates, though the actual rate is likely much lower. Even though breast cellulitis can be 'multifocal' in presentation, it is believed to be primarily caused by a bacterial infection, in combination with impaired lymphatic drainage channels. About 50% of patients with breast cellulitis will have to deal with the condition for 4 months to 1 year after it develops. The annual risk for the development of delayed breast cellulitis is estimated to be in the range of 0.8%. The average time of development of breast cellulitis is around 3 to 5 months postradiotherapy, but there are instances of the condition developing even many years after breast cancer therapy has been completed.

Treatment for breast cellulitis

Breast cellulitis will usually be treated with antibiotics and other treatments to relieve local symptoms such as pain and fever. If the condition seems to persist after 3-4 months of treatment by antibiotics, a biopsy might be performed to check for the possibility of a local breast cancer recurrence.

 

References

  1. Staren ED; Klepac S; Smith AP; Hartsell WF; Segretti J; Witt TR; Griem KL; Bines SD., The dilemma of delayed cellulitis after breast conservation therapy. Arch Surg 1996 Jun;131(6):651-4
  2. Hughes LL; Styblo TM; Thoms WW; Schwarzmann SW; Landry JC; Heaton D; Carlson GW; Wood WC., Cellulitis of the breast as a complication of breast-conserving surgery and irradiation. Am J Clin Oncol 1997 Aug;20(4):338-41.
  3. Mertz KR; Baddour LM; Bell JL; Gwin JL., Breast cellulitis following breast conservation therapy: a novel complication of medical progress. Clin Infect Dis 1998 Feb;26(2):481-6.
  4. Indelicato DJ; Grobmyer SR; Newlin H; Morris CG; Haigh LS; Copeland EM 3rd; Mendenhall NP., Delayed breast cellulitis: an evolving complication of breast conservation. Int J Radiat Oncol Biol Phys. 2006 Dec 1;66(5):1339-46.
  5. Rescigno J; McCormick B; Brown AE; Myskowski PL., Breast cellulitis after conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys 1994 Apr 30;29(1):163-8.
  6. Brewer VH, Hahn KK, Rohrbach BW, et al: Risk factor analysis for breast cellulitis complicating breast conservation therapy. Clin Infect Dis 31:654-659, 2000.
  7. Meric F, Buchholz TA, Mirza NQ, et al: Long-term complications associated with breast-conservation surgery and radiotherapy. Ann Surg Oncol 9:543-549, 2002.
  8. Staren ED; Klepac S; Smith AP; Hartsell WF; Segretti J; Witt TR; Griem KL; Bines SD. The dilemma of delayed cellulitis after breast conservation therapy. Arch Surg 1996 Jun;131(6):651-4.
  9. Hughes LL; Styblo TM; Thoms WW; Schwarzmann SW; Landry JC; Heaton D; Carlson GW; Wood WC., Cellulitis of the breast as a complication of breast-conserving surgery and irradiation. Am J Clin Oncol 1997 Aug;20(4):338-41.
  10. Indelicato DJ; Grobmyer SR; Newlin H; Morris CG; Haigh LS; Copeland EM 3rd; Mendenhall NP.,
    Delayed breast cellulitis: an evolving complication of breast conservation. Int J Radiat Oncol Biol Phys. 2006 Dec 1;66(5):1339-46.
  11. Baddour, LM., Breast cellulitis complicating breast conservation therapy. Journal of Internal Medicine 1999; 245: 5–9
  12. Simon MS, Cody RL. Cellulitis after axillary lymph node dissection for carcinoma of the breast. Am J Med 1992; 93:543-8.
  13. Schwarz, MN., Cellulitis. New England Journal of Medicine, (February 2004) Volume 350:9 p. 904-912.
  14. Frassica, DA., Bajaj, GK., Tsangaris, TN., Treatment of Complications After Breast-Conservation Therapy Oncology, Vol. 17 No. 8
  15. Keidan R, Hoffman J, Weese J, et al: Delayed breast abscesses after lumpectomy and radiation therapy. Am Surg 56:440-444, 1990.
  16. Szuba A, Achalu R, Rockson SG (2002). Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression.. Cancer 95 (11): 2260–7.

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