title: Delayed breast cellulitis: an evolving complication of breast conservation.
abstract: OBJECTIVE
  Delayed breast cellulitis (DBC) is characterized by the late onset of breast erythema, edema, tenderness, and warmth. This retrospective study analyzes the risk factors and clinical course of DBC.
  
  
  METHODS
  From 1985 through 2004, 580 sequential women with 601 stage T0-2N0-1 breast cancers underwent breast conserving therapy. Cases of DBC were identified according to accepted clinical criteria: diffuse breast erythema, edema, tenderness, and warmth occurring >3 months after definitive surgery and >3 weeks after radiotherapy. Potential risk factors analyzed included patient comorbidity, operative technique, acute complications, and details of adjunctive therapy. Response to treatment and long-term outcome were analyzed to characterize the natural course of this syndrome.
  
  
  RESULTS
  Of the 601 cases, 16%, 52%, and 32% were Stage 0, I, and II, respectively. The overall incidence of DBC was 8% (50/601). Obesity, ecchymoses, T stage, the presence and aspiration of a breast hematoma/seroma, removal of >5 axillary lymph nodes, and arm lymphedema were significantly associated with DBC. The median time to onset of DBC from the date of definitive surgery was 226 days. Ninety-two percent of DBC patients were empirically treated with antibiotics. Fourteen percent required more invasive intervention. Twenty-two percent had recurrent episodes of DBC. Ultimately, 2 patients (4%) underwent mastectomy for intractable breast pain related to DBC.
  
  
  CONCLUSIONS
  Although multifactorial, we believe DBC is primarily related to a bacterial infection in the setting of impaired lymphatic drainage and may appear months after completion of radiotherapy. Invasive testing before a trial of antibiotics is generally not recommended.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Indelicato
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.forename: Heather
authors.initials: H
authors.lastname: Newlin
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Linda S
authors.initials: LS
authors.lastname: Haigh
authors.forename: Edward M
authors.initials: EM
authors.lastname: Copeland
authors.forename: Nancy Price
authors.initials: NP
authors.lastname: Mendenhall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001941:Breast Diseases / Q000209:etiology*; D001943:Breast Neoplasms / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery; D002481:Cellulitis / Q000209:etiology*; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000209:etiology; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors