Breast Abscess Treatment
The recommended first-line treatment for breast abscesses is ultrasound-guided needle aspiration combined with appropriate antibiotic therapy, regardless of abscess size. 1, 2
Diagnostic Approach
- Ultrasound examination is essential to confirm diagnosis and characterize the abscess 1, 3
- Collect samples of milk or abscess material for microbiological testing to guide antibiotic therapy 1
Treatment Algorithm
1. Needle Aspiration
- For abscesses ≤3 cm: Single needle aspiration is often sufficient 3, 2
- For abscesses >3 cm but <5 cm: Consider ultrasound-guided percutaneous catheter drainage 3, 2
- For abscesses >5 cm:
Multiple aspiration sessions may be required for complete resolution. In one study, 19 patients required only a single aspiration, while 9 needed multiple aspirations 4.
2. Antibiotic Therapy
- Empiric broad-spectrum antibiotics covering Gram-positive, Gram-negative, and anaerobic bacteria 5
- First-line oral options:
- Adjust antibiotics based on culture results 1
3. Surgical Incision and Drainage
Reserve for cases where needle aspiration fails or for:
- Large (>5 cm), multiloculated, or long-standing abscesses 2
- Chronic abscesses that don't respond to percutaneous drainage 3
- Recurrent subareolar abscesses with fistula formation 2
Special Considerations for Lactating Women
- Needle aspiration is particularly beneficial for lactating women as it:
- Causes less pain
- Avoids separation of mother and child
- Allows quicker return to breastfeeding
- Prevents interruption of milk ducts 1
- Most women can continue breastfeeding during treatment 1
Follow-up and Monitoring
- Reassess after 48-72 hours for clinical improvement 5
- Perform repeat ultrasound if clinical improvement is not observed 5
- Consider additional aspirations if fluid reaccumulates 4
Outcomes and Success Rates
- Needle aspiration success rates range from 82-90% 4, 1
- Factors associated with successful aspiration include:
- Smaller initial volume of pus (4.0 mL vs 21.5 mL)
- Earlier presentation (5.0 days vs 8.5 days) 4
- Recurrence rates are similar between aspiration (20%) and surgical incision (19%) 6
Advantages of Needle Aspiration over Surgical Drainage
- Outpatient procedure
- Shorter hospital stays (1-2 days vs 2-3 days) 6
- No general anesthesia required
- Better cosmetic outcomes
- Shorter healing time
- Lower cost
- Easily repeatable 1, 2
Needle aspiration with appropriate antibiotic therapy represents the most effective and patient-friendly approach to managing breast abscesses, with surgical drainage reserved for specific cases where aspiration fails or is inappropriate.