What is the treatment for a small breast abscess?

From the Guidelines

For small breast abscesses, incision and drainage is the primary treatment, and antibiotics are not needed unless there are signs of systemic infection or the abscess is large or complex. The most recent and highest quality study, published in 2018 1, recommends that simple abscesses or boils be treated with incision and drainage alone, without the need for antibiotics. This approach is supported by other studies, including one from 2011 1, which notes that incision and drainage is likely adequate for most simple abscesses, and that antibiotics may not provide any additional benefit. Another study from 2005 1 also recommends incision and drainage as the primary treatment for cutaneous abscesses, with antibiotics only being necessary in unusual cases, such as multiple lesions or severely impaired host defenses.

Some key points to consider when treating small breast abscesses include:

• Incision and drainage is the primary treatment, and should be performed by a healthcare professional
• Antibiotics should only be used if there are signs of systemic infection, such as fever or chills, or if the abscess is large or complex
• Empiric antibiotic therapy should be started immediately if MRSA is suspected, typically with clindamycin or trimethoprim-sulfamethoxazole
• Pain management with acetaminophen or ibuprofen is also important, as is the use of warm compresses to improve blood circulation and promote healing
• Breastfeeding mothers should continue nursing or expressing milk from the affected breast to prevent milk stasis, which can worsen the condition

It's worth noting that the treatment of small breast abscesses should prioritize minimizing morbidity, mortality, and improving quality of life. Therefore, a conservative approach with incision and drainage, and antibiotics only when necessary, is recommended.

From the Research

Treatment Options for Small Breast Abscess

• The treatment for a small breast abscess can include antibiotics and needle aspiration 2, 3, 4.
• Studies have shown that the Mammotome biopsy system can be an effective treatment strategy for breast abscesses, especially for those with an abscess size ≤ 3.5 cm 2.
• Ultrasound-guided needle aspiration has been found to be a viable alternative to surgical incision and drainage, with advantages including minimal invasiveness, reduced risk of recurrence, and superior cosmetic outcomes 3, 5, 6.
• A conservative approach with antibiotic therapy and needle aspiration, if feasible, can be an effective treatment for breast abscesses, regardless of size and clinical features 3.

Comparison of Treatment Methods

• A randomized controlled trial comparing ultrasonography-guided needle aspiration and surgical drainage found that needle aspiration had a significant reduction in post-intervention pain, healing time, and scar formation 5.
• Another study found that sonographically guided percutaneous aspiration of breast abscesses did not extend the length of intravenous antibiotic treatment or hospital stay, and did not lead to an increase in the need for analgesic drugs 6.
• Non-operative treatment by needle aspiration and oral antibiotics has been reported as a viable alternative to surgical incision and drainage, with a high success rate and minimal recurrence 4.

Considerations for Lactating Women

• Breast abscesses in lactating women can be treated with antibiotic therapy and needle aspiration, allowing for continued breastfeeding 3, 5.
• A study found that 40.6% of women with breast abscesses continued to breastfeed for more than 6 months, and only 21 mothers interrupted breastfeeding before 3 months 3.