What is the treatment for a breast abscess during pregnancy?

Treatment of Breast Abscess During Pregnancy

The treatment of breast abscess during pregnancy involves ultrasound-guided needle aspiration combined with appropriate antibiotics, while continuing breastfeeding to facilitate drainage of the affected breast. 1

Diagnosis

• Clinical diagnosis based on:
  • Focal breast tenderness
  • Overlying skin erythema or hyperpigmentation
  • Systemic symptoms (fever, malaise)
  • Ultrasonography to confirm presence and extent of abscess collection

Management Algorithm

First-line Treatment

1. Ultrasound-guided needle aspiration

   • Preferred over surgical incision and drainage, especially during pregnancy 2
   • May require repeated aspirations until resolution 3
   • Provides excellent cosmetic results 4
   • Can be performed under local anesthesia as an outpatient procedure

2. Antibiotic therapy

   • Initiate antibiotics effective against Staphylococcus aureus:
     • Dicloxacillin or cephalexin as first-line options 1
     • Clindamycin for penicillin-allergic patients (safe during pregnancy) 5
   • Continue for 10-14 days

3. Continue breastfeeding

   • Essential component of treatment 1
   • Facilitates milk removal which is crucial for resolving infection
   • Does not pose risk to infant
   • Prevents engorgement and worsening of condition

Supportive Measures

• Pain management with pregnancy-safe analgesics (acetaminophen, ibuprofen)
• Warm compresses before feeding to facilitate milk flow
• Ensure proper breastfeeding technique and infant latch
• Adequate hydration and rest

When to Consider Surgical Drainage

• Failed response to repeated aspirations
• Multiloculated abscess not amenable to aspiration
• Development of fistula
• Recurrent or chronic abscess

Special Considerations During Pregnancy

• Ultrasound is the imaging modality of choice (no radiation exposure)
• Antibiotic selection must consider pregnancy safety profile
• Surgical procedures requiring general anesthesia should be performed with obstetrical consultation, especially after 25 weeks gestation 6
• Fetal monitoring should be considered during any surgical intervention after viability 6

Follow-up

• Repeat ultrasound to confirm resolution
• Continue antibiotics for the full prescribed course
• Monitor for recurrence or complications

Outcomes and Prognosis

Studies show that 90-95% of breast abscesses can be successfully treated with needle aspiration and antibiotics 2, 7, with excellent cosmetic results and low recurrence rates. Even larger abscesses (>3cm) associated with pregnancy and lactation can be effectively managed with aspiration 8.

Common Pitfalls to Avoid

• Delaying treatment, which increases risk of complications
• Discontinuing breastfeeding, which can worsen engorgement and slow recovery 1
• Inadequate drainage or premature cessation of antibiotics
• Failure to address underlying causes (e.g., poor breastfeeding technique)
• Missing inflammatory breast cancer, which can mimic abscess presentation

The evidence strongly supports ultrasound-guided aspiration as a safe, effective, and less invasive alternative to traditional surgical drainage for breast abscesses during pregnancy, with the added benefits of preserving breast function and cosmesis.