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 (the skin).
Breast cellulitis can occur anywhere there is a wound to the skin, but may also occur in the breast following breast cancer treatments.
What are the symptoms of Breast Cellulitis?
Essentially, it is an inflammatory reaction to an infection, that can cause the following symptoms:-
- Build-up of fluids (edema)
- Rash and redness (erythema)
So, 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.
Fever and toxicity, due to the involvement of the lymphatic system, are symptoms of breast cellulitis. Some women may also experience relentless chills, and leukocytosis (an increase in the white blood cell count).
Cellulitis of the breast is usually caused by an opportunistic infection
Even though the condition is caused by an opportunistic infection, medics believe that the ‘stasis’ of movement of fluid through lymphatic channels might provide an opportunity for bacterial growth.
‘Microtrauma’ (extremely small tears in the skin) may also precipitate breast cellulitis. There is also growing support of the idea that breast cancer patients who are post-treatment for seroma of the breast might also be at a higher risk for developing 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 cellulitis is not that high, ranging from 5% to 8% according to some estimates, though the actual rate is likely much lower.
Even though breast cellulitis can be ‘multifocal’ in presentation, specialists believe the primary cause is a bacterial infection. The infection may occur 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.
Studies estimate that the annual risk for the development of delayed breast cellulitis is in the range of 0.8%. The average time of development of breast cellulitis is around 3 to 5 months post-radiotherapy. However, there are instances of the condition developing even many years after the completion of breast cancer therapy.
Treatment for breast cellulitis
Antibiotics is usually the main treatment for breast cellulitis. However, doctors may prescribe other treatments to relieve local symptoms, such as pain and fever.
If the condition persists after 3 to 4 months of treatment by antibiotics, a biopsy might be necessary to check for the possibility of local breast cancer recurrence.
Could it be cancer?
You will want to read about inflammatory breast cancer and look at the pictures AND, you need some patience to give antibiotics a chance to work.
But not too much patience … if the antibiotics aren’t working and the problem gets worse and worse, see your doctor and ask them about a skin biopsy to rule out inflammatory cancer. It’s rare but good to know about.
- Indelicato DJ, Grobmyer SR, Newlin H, Morris CG, Haigh LS, Copeland EM, Mendenhall NP. (2006) Delayed breast cellulitis: an evolving complication of breast conservation. Int J Radiat Oncol Biol Phys. 2006 Dec 1;66(5):1339-46. https://www.ncbi.nlm.nih.gov/pubmed/17126205
- Schwarz MN. (2004) Cellulitis. New England Journal of Medicine, (February 2004) Volume 350:9 p. 904-912.
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