From the Guidelines
The initial workup for a breast abscess should include a thorough clinical examination, ultrasound imaging, and culture of the abscess fluid. Begin with a detailed history and physical examination to assess symptoms like pain, erythema, swelling, and fever. Ultrasound is the preferred imaging modality as it can distinguish between an abscess and other breast masses while guiding aspiration or drainage procedures 1. Needle aspiration should be performed to obtain fluid for culture and sensitivity testing to identify the causative organism, most commonly Staphylococcus aureus. Laboratory tests including complete blood count may be ordered to assess for systemic infection.
Some key points to consider in the workup and management of breast abscesses include:
- The use of ultrasound as the initial imaging modality, especially in younger women, due to its higher sensitivity in this age group 1.
- The importance of correlating imaging findings with the clinical examination to ensure accurate diagnosis and appropriate management 1.
- The role of mammography or digital breast tomosynthesis (DBT) in evaluating women over 40 years with a palpable mass, or in younger women with suspicious findings on ultrasound 1.
- The need for empirical antibiotic therapy in cases of purulent cellulitis or abscess, with coverage for CA-MRSA and beta-hemolytic streptococci 1.
Treatment typically involves antibiotics such as dicloxacillin 500 mg orally four times daily or clindamycin 300-450 mg orally four times daily for 7-10 days for patients allergic to penicillin. Drainage is essential, either through ultrasound-guided needle aspiration for smaller abscesses (<3 cm) or surgical incision and drainage for larger ones. Patients should be advised to continue breastfeeding if lactating, as this helps with drainage and healing. Pain management with acetaminophen or ibuprofen is also important. This comprehensive approach addresses both diagnosis and treatment while preventing complications such as recurrence or extensive tissue damage.
From the Research
Initial Workup for Breast Abscess
The initial workup for a breast abscess typically involves a combination of diagnostic imaging and clinical assessment.
- Ultrasonographic scan to confirm the presence of an abscess and to guide aspiration 2, 3, 4
- Aspiration of any pus to obtain a sample for microbiological testing and to reduce the size of the abscess 2, 5, 3, 6, 4
- Antibiotic therapy to treat the underlying infection 2, 5, 3, 6
Diagnostic Imaging
Ultrasonography is the preferred imaging modality for diagnosing breast abscesses, as it can help identify the presence and size of the abscess, as well as guide aspiration 2, 3, 4.
- Ultrasonography can also help differentiate between an abscess and other breast lesions, such as inflammatory masses or cysts 2
Treatment Options
The treatment of breast abscesses depends on the size and severity of the abscess, as well as the patient's overall health.
- Needle aspiration and antibiotic therapy are often used as a first-line treatment for small to moderate-sized abscesses 2, 5, 3, 6
- Incision and drainage may be necessary for larger or more complex abscesses, or for those that do not respond to aspiration and antibiotic therapy 2, 5, 4
- Repeated needle aspirations may be necessary to completely drain the abscess and prevent recurrence 5, 3, 6