From the Guidelines
Breast abscesses should be treated with drainage of the abscess combined with antibiotics, with the primary treatment being incision and drainage for simple abscesses or boils, as recommended by the Infectious Diseases Society of America 1, 2, 3.
Diagnosis and Treatment
A breast abscess is a localized collection of pus within the breast tissue, typically resulting from untreated mastitis or bacterial infection. The diagnosis is usually made based on clinical presentation, including symptoms such as pain, redness, and swelling of the breast, and confirmed by ultrasound or other imaging modalities.
Treatment Approach
- For small abscesses (<5 cm), needle aspiration under ultrasound guidance is preferred, which may need to be repeated 2-3 times if reaccumulation occurs.
- Larger abscesses may require surgical incision and drainage.
- Antibiotic therapy should include coverage for Staphylococcus aureus, the most common causative organism.
- Dicloxacillin 500 mg orally four times daily or cephalexin 500 mg orally four times daily for 7-10 days is typically effective.
- For patients with MRSA risk factors or penicillin allergy, clindamycin 300-450 mg orally four times daily is appropriate, as recommended by the Infectious Diseases Society of America 1, 2, 3.
Additional Considerations
- Pain management with acetaminophen or ibuprofen is recommended.
- Breastfeeding mothers should continue nursing from the unaffected breast and can resume nursing from the affected breast once drainage is complete and antibiotics have been started.
- Warm compresses applied to the affected area for 15-20 minutes several times daily can help improve circulation and promote healing.
- Recurrent abscesses may indicate underlying conditions requiring further investigation, including mammography to rule out inflammatory breast cancer in non-lactating women.
- The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended 1, 2, 3.
- Cultures from abscesses and other purulent SSTIs 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 2, 3.
From the Research
Diagnosis of Breast Abscess
- Breast abscesses can be diagnosed using ultrasonographic scans to confirm the presence of pus or inflammation in the breast tissue 4, 5, 6
- The diagnosis is often made based on clinical presentation, patient history, and physical examination, followed by imaging studies to confirm the diagnosis
Treatment of Breast Abscess
- Non-operative treatment by needle aspiration and oral antibiotics is a viable alternative to surgical incision and drainage for non-lactational breast abscesses 7
- Aspiration combined with ultrasonographic imaging is an effective alternative to incision and drainage for breast abscesses 4
- US-guided serial percutaneous aspiration and local antibiotic therapy can be used to treat acute breast abscesses that are not responsive to systemic antibiotics 5
- Antibiotic therapy should be targeted at the causative organism, with consideration of methicillin-resistant Staphylococcus aureus (MRSA) as a common cause of breast abscesses 8, 6
- A conservative approach with antibiotic therapy and needle aspiration, if feasible, can be used to treat breast abscesses in breastfeeding mothers, regardless of the size and clinical features of the abscess 6
Management of Breast Abscess
- Breast abscesses can be managed using a combination of needle aspiration, antibiotic therapy, and ultrasonographic imaging 7, 4, 5, 6
- The choice of empirical antibiotics should be based on the institutional antibiogram and should consider the possibility of MRSA as a causative organism 8
- Needle aspiration is a cost-effective method that can be used to treat breast abscesses, with the advantage of being an outpatient procedure that does not require separation of the mother-child dyad and allows for a quicker return to breastfeeding 6