Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Breast sepsis or rapidly progressive inflammatory change
Systemic toxicity, hypotension, rapidly spreading erythema, severe pain, fluctuance or skin necrosis indicates complicated mastitis, abscess or rarely necrotising infection; diffuse peau d’orange without sepsis may be inflammatory breast cancer.
Action: Use ABCDE assessment, obtain sepsis investigations, start appropriate antibiotics and arrange urgent ultrasound-guided drainage and breast or surgical review; if inflammatory change persists or lacks infective features, secure urgent imaging and skin or breast tissue diagnosis rather than extending empirical antibiotics.
Synopsis
Assess a new breast or axillary lump without delay, recognise infection and inflammatory cancer, complete concordant clinical, imaging and tissue assessment and route benign, uncertain and malignant findings safely.
Triple assessment means clinical history and examination, appropriate breast imaging and pathological sampling when indicated; diagnostic confidence depends on concordance between all three components.
Refer adults meeting suspected-cancer criteria promptly. A painful lump can still be malignant, and young age or pregnancy does not remove the need for assessment.
Ultrasound is usually the first imaging test in younger patients and during pregnancy or lactation; mammography is central from the usual screening-age range and is commonly combined with targeted ultrasound.
Key red flags
A hard irregular fixed breast mass, skin tethering, nipple distortion or a suspicious axillary or supraclavicular node requires urgent cancer-pathway assessment.
Inflammatory cancer
Rapid diffuse enlargement, erythema, peau d’orange and breast heaviness without convincing sepsis or antibiotic response requires urgent tissue diagnosis.
Investigation priorities
01
First-line clinical breast and nodal examinationFirst stepFirst line
Localise the abnormality and identify skin, nipple, chest-wall and regional-node findings that determine imaging urgency.
02
First-line targeted breast ultrasoundFirst line
Differentiate cystic and solid lesions, evaluate margins and vascularity and assess axillary nodes without ionising radiation.
Management branches
New lumpComplete concordant triple assessment
A patient reports a persistent breast or axillary lump or examination finds a focal abnormality.
Take a focused cancer, reproductive, infection, trauma and family history and examine both breasts, nipples and regional nodes, documenting the target accurately.
Arrange age- and context-appropriate mammography and targeted ultrasound through the symptomatic breast service rather than ordering isolated tests without review.
Key medicines
Flucloxacillin for uncomplicated bacterial mastitisA common adult regimen is flucloxacillin 500 mg orally four times daily for 10 to 14 days, adjusted to local antimicrobial guidance, allergy, culture, severity and renal or hepatic context.
Paracetamol for breast painGive 500 mg to 1 g orally up to four times daily when required, at least 4 hours apart and to a usual maximum of 4 g in 24 hours; use a lower ceiling when clinically indicated.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.