subareolar abscess and treatment of granulomatous mastitis). according to a bmj best practice report, antibiotics are generally to be used in all nonpuerperal mastitis cases, with replacement of the antibiotics by an antifungal agent such as fluconazole in cases of deep fungal infections, and corticosteroids are to be used in case of granulomatous mastitis (with differential diagnosis to tuberculosis infection of the breast). in idiopathic granulomatous mastitis, successful treatment includes invasive surgical procedures or less invasive treatment with steroid medications. antibiotics in lactational mastitis, antibiotics are not needed in the overwhelming majority of cases and should be used only for bacterial infections. for people with nonsevere infections, dicloxacillin or cephalexin are recommended. for people with severe infections, vancomycin is recommended. the length of antibiotic treatment ranges anywhere from 5–14 days. the effects of antibiotics has not been well studied as of 2013. breast abscess an abscess (or suspected abscess) in the breast may be treated by ultrasound-guided fine-needle aspiration (percutaneous aspiration) or by surgical incision and drainage; each of these approaches is performed under antibiotic coverage. in case of puerperal breast abscess, breastfeeding from the affected breast should be continued where possible. for small breast abscesses, ultrasound-guided fine needle aspiration such as to completely drain the abscess is widely recognized as a preferred initial management. one recommended treatment includes antibiotics, ultrasound evaluation and, if fluid is present, ultrasound-guided fine needle aspiration of the abscess with an 18 gauge needle, under saline lavage until clear. the exudate is then sent for microbiological analysis for identification of the pathogen and determination of its antibiotic sensitivity profile, which may in turn give an indication for changing the antibiotics. at follow-up, a mammography is performed if the condition has resolved; otherwise the ultrasound-guided fine-needle aspiration with lavage and microbiological analysis is repeated. if three to five aspirations still do not resolve the condition, percutaneous drainage in combination with placement of an indwelling catheter is indicated, and only if several attempts at ultrasound-guided drainage fail, surgical resection of the inflamed lactiferous ducts (preferably performed after the acute episode is over). it is noted, however, that even the excision of the affected ducts does not necessarily prevent recurrence. nonpuerperal breast abscesses have a higher rate of recurrence compared to puerperal breast abscesses. there is a high statistical correlation of nonpuerperal breast abscess with diabetes mellitus (dm). on this basis, it has recently been suggested that diabetes screening should be performed on patients with such abscess. although there are a number of recommendations regarding the treatment of breast abscesses, a 2015 review found insufficient evidence of whether needle aspiration is comparable to incision and drainage, or whether antibiotics should generally be given to women undergoing incision and drainage. prognosis temperature and severity of symptoms at presentation do not predict outcome; women with sore or damaged nipples may need special attention. epidemiology mastitis is quite common among breastfeeding women. the who estimates that although incidences vary between 2.6% and 33%, the prevalence globally is approximately 10% of breastfeeding women. most mothers who develop mastitis usually do so within the first few weeks after delivery. most breast infections occur within the first or second month after delivery or at the time of weaning. however, in rare cases it affects women who are not breastfeeding. terminology popular usage of the term mastitis varies by geographic region. outside the us it is commonly used for puerperal and nonpuerperal cases, in the us the term nonpuerperal mastitis is rarely used and alternative names such as duct ectasia, subareolar abscess and plasma cell mastitis are more frequently used. chronic cystic mastitis is an older name for fibrocystic disease. american usage: mastitis usually refers to puerperal (occurring to breastfeeding mothers) mastitis with symptoms of systemic infection. lighter cases of puerperal mastitis are often called breast engorgement. in this article, "mastitis" is used in the original sense of the definition as inflammation of the breast with additional qualifiers where appropriate. etymology and pronunciation the word mastitis (/mæstˈaɪtɪs/) uses combining forms of mast- + -itis. the word mammitis (/mæmˈaɪtɪs/) uses combining forms of mamm- + -itis. they are synonymous in modern usage, and mastitis is the more commonly used synonym. other animals mastitis occurs in other animals as in humans, and is especially a concern in livestock, since milk from the affected udders of livestock may enter the food supply and pose a health risk. it is a major condition in some species, like dairy cows. it is the cause of much unwanted suffering for the dairy cows. it is of tremendous economic importance for the dairy industry, and it is also of concern for public health. the same considerations apply to mastitis in sheep and goats and other milk-producing females. it is also of economic importance in the sow, but, in this species, it is not related to public health. in other domestic females (queen, mare, etc.), it is more an individual illness dealt with by veterinary practitioners. udder of a roux du valais sheep after a healed mastitis; one teat was lost due to the disease. serous exudate from bovine udder in e. coli mastitis at left. normal milk at right. gangrenous mastitis in a dairy cow. cat with mastitis