What is the treatment for an infected sebaceous cyst of the breast?

Treatment of Infected Sebaceous Cyst of the 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, followed by complete excision of the cyst wall once the infection resolves to prevent recurrence. 1

Diagnostic Approach

• Infected sebaceous cysts typically present as:
  • Painful, tender, fluctuant red nodule
  • Surrounding erythematous swelling
  • May have purulent discharge
• Must be differentiated from other breast masses, including malignancy
• Ultrasound can help differentiate between simple, complicated, and complex cysts 2

Treatment Algorithm

1. Acute Infection Management

• Incision and drainage (I&D) is the cornerstone of treatment 1
  • Make an adequate incision to allow complete drainage
  • Thoroughly evacuate all purulent material
  • Probe the cavity to break up loculations
  • Remove any necrotic tissue or debris

2. Antibiotic Considerations

• Systemic antibiotics are rarely necessary for isolated infected sebaceous cysts 1
• Consider antibiotics only in cases with:
  • Multiple lesions
  • Extensive surrounding cellulitis
  • Severely immunocompromised patients
  • Systemic manifestations of infection
  • Treatment failure

3. Wound Management

• Cover the wound with a dry dressing
• Avoid frequent dressing changes to prevent cross-infection 1
• Monitor for adequate drainage and healing

4. Definitive Management

• Complete excision of the cyst wall once infection resolves 1
  • This is crucial to prevent recurrence
  • Should include removal of the entire cyst capsule

Alternative Approaches

An emerging technique described by Mymensingh Medical Journal involves excising the infected tissue along with a rim of healthy tissue and then closing with Prolene sutures in the same sitting 3. This approach may offer:

• Quicker recovery
• Reduced need for frequent dressing changes
• Cost-effectiveness
• Time savings

Important Considerations and Pitfalls

Diagnostic Pitfalls

• Beware of malignancy masquerading as sebaceous cysts
  • Angiosarcoma can mimic an infected sebaceous cyst 4
  • Ectopic breast carcinoma can present similarly to axillary sebaceous cysts 5

Management Caveats

1. Ensure complete drainage: Inadequate drainage can lead to persistent infection
2. Complete excision is key: Failure to remove the entire cyst wall leads to high recurrence rates
3. Consider ultrasound guidance: For complex or recurrent cases, ultrasound-guided aspiration with local antibiotic injection may be considered as an alternative approach 6
4. Follow-up is essential: Monitor for complete resolution and consider definitive excision once infection has resolved

By following this structured approach to infected sebaceous cysts of the breast, you can effectively manage the acute infection while preventing recurrence through definitive treatment.