What is the recommended treatment for a breast abscess?

From the Guidelines

The recommended treatment for a breast abscess typically involves a combination of drainage and antibiotics, with the primary intervention being drainage of the abscess through needle aspiration or surgical incision and drainage, as supported by the most recent guidelines 1.

Key Considerations

• The primary treatment for a breast abscess is incision and drainage, which can be done through needle aspiration under ultrasound guidance for smaller abscesses or surgical incision and drainage for larger or complex abscesses.
• Antibiotics are usually prescribed to treat the underlying infection, with common choices including dicloxacillin, cephalexin, or clindamycin for 7-10 days.
• For methicillin-resistant Staphylococcus aureus (MRSA), trimethoprim-sulfamethoxazole or doxycycline may be used, as recommended by the Infectious Diseases Society of America 1.

Treatment Approach

• The treatment approach should be individualized based on the patient's clinical response and the severity of the infection.
• Pain management with acetaminophen or ibuprofen is also important, and warm compresses applied to the affected area can help with healing and pain relief.
• If the abscess occurs in a lactating woman, breastfeeding should continue, preferably on the unaffected breast first, though milk can be safely expressed from the affected breast after drainage.

Follow-up and Prevention

• Follow-up is recommended to ensure complete resolution and prevent recurrence, as supported by the guidelines 1.
• Cultures from abscesses and other purulent skin and soft-tissue infections are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1.

From the Research

Treatment Options for Breast Abscess

The recommended treatment for a breast abscess includes:

• Needle aspiration either with or without ultrasound guidance as the first line of treatment 2
• Ultrasound-guided percutaneous catheter placement as an alternative approach for larger abscesses (>3 cm) 2
• Surgical incision and drainage for large (>5 cm), multiloculated, or long-standing abscesses, or if percutaneous drainage is unsuccessful 2

Comparison of Treatment Modalities

Studies have compared the efficacy of different treatment approaches, including:

• Incision and drainage versus needle aspiration, with results showing that ultrasound-guided aspiration is a better treatment modality than incision and drainage 3
• Conventional incision and drainage versus ultrasound-guided needle aspiration, with findings indicating that ultrasound-guided aspiration is associated with shorter healing times, lower rates of residual abscesses, and better cosmetic outcomes 4

Factors Affecting Treatment Success

Factors that affect the success of treatment include:

• Abscess size and volume, with smaller abscesses being more likely to be successfully treated with needle aspiration 5
• Presence of multiloculated lesions, which can reduce the effectiveness of needle aspiration 6
• Timing of treatment, with earlier presentation being associated with better outcomes 5

Additional Considerations

All patients with breast abscesses should be treated concurrently with antibiotics 2 Patients with recurrent subareolar abscesses and fistulas should be referred for consideration of surgical treatment 2