Treatment for Infected Sebaceous Cyst on Breast
The primary treatment for an infected sebaceous cyst on the breast is incision and drainage, with thorough evacuation of the pus and probing of the cavity to break up loculations. 1
Diagnosis and Initial Assessment
- Look for signs of infection: painful, tender, fluctuant red nodule, often with surrounding erythematous swelling
- Differentiate from other breast masses:
- Sebaceous (epidermoid) cysts: contain cheesy keratinous material
- Note: These are often erroneously labeled "sebaceous cysts" when they are actually epidermoid cysts 1
Treatment Algorithm
Step 1: Incision and Drainage
- Make an adequate incision to allow complete drainage
- Thoroughly evacuate all pus
- Probe the cavity to break up loculations
- Remove any necrotic tissue or debris 1
Step 2: Wound Management
- Simply cover the surgical site with a dry dressing (most effective approach)
- Some clinicians may pack with gauze or suture it closed
- Avoid frequent dressing changes to prevent cross-infection 2
Step 3: Antibiotic Consideration
- Systemic antibiotics are rarely necessary 1
- Consider antibiotics only in these exceptional cases:
- Multiple lesions
- Cutaneous gangrene
- Severely impaired host defenses
- Extensive surrounding cellulitis
- Severe systemic manifestations (high fever, SIRS) 1
Step 4: Complete Removal
- For definitive treatment, complete excision of the cyst wall is recommended once infection resolves
- This prevents recurrence 2
Special Considerations
When to Perform Gram Stain and Culture
- Gram stain and culture of pus from infected cysts are not routinely recommended 1
- Cultures may be considered in cases with:
- Unusual presentation
- Treatment failure
- Immunocompromised patients
Differential Diagnosis
- Be vigilant about unusual presentations that might mimic infected sebaceous cysts
- Rare cases of malignancy (like angiosarcoma) have been initially misdiagnosed as infected sebaceous cysts 3
- Consider biopsy for atypical presentations or treatment failures
Follow-up Care
- Assess wound healing at appropriate intervals
- Consider complete excision of the cyst after infection resolves to prevent recurrence
- Return to routine breast screening if no concerning features
Common Pitfalls to Avoid
- Delaying incision and drainage when infection is present
- Overuse of antibiotics when not indicated
- Failing to completely remove the cyst wall, leading to recurrence
- Missing rare malignancies that present similarly to infected cysts 3
- Inadequate drainage or failure to break up loculations
By following this treatment approach, most infected sebaceous cysts on the breast can be effectively managed with minimal complications and good cosmetic outcomes.