Background: The differential diagnosis of a red breast is extensive and includes both benign and malignant diseases. The literature documents patients who present with a red breast with delays in diagnosis of inflammatory cancer. We recorded our institutional experience prospectively in the evaluation, diagnosis, and treatment of a red breast.
Methods: Data were collected prospectively on patients who presented with a red breast during a 14-month period. A retrospective review of final diagnosis and outcome was then conducted. A PubMed and Ovid Medline literature search were performed.
Results: Twenty-two patients presented with a red breast. This number accounted for only 0.6% (22/3,762) of patients evaluated in our breast center during this time period. Final diagnoses were as follows: mastitis in 31.8%, breast abscess in 13.6%, erythematous changes secondary to radiation therapy in 13.6%, cellulitis in 9.1%, and venous hypertension in 9.1%. Other diagnoses included postradiation morphea, benign dermatologic inflammation, Paget disease of the breast, inflammatory breast cancer, and psoriasis (1 patient each). After treatment, 67% (17/22) patients had resolution of their symptoms and 18% (4/22) were improved. Only 1 (4.5%) of 22 patients had a change in diagnosis in a median follow-up of 8.8 months.
Conclusion: A red breast is an uncommon presenting complaint in patients evaluated at a breast center; however, the differential diagnosis is extensive. With appropriate diagnosis and treatment, most patients will have improvement or resolution of their symptoms. The diagnostic algorithm used by our breast center identified the cause of the red breast correctly in >95% of patients at presentation, and it can serve as a guide to evaluate patients with a red breast. This algorithm is in agreement with National Comprehensive Cancer Network guidelines.
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