What is the recommended treatment for a breast abscess?

Treatment of Breast Abscess

The recommended first-line treatment for breast abscess is ultrasound-guided needle aspiration combined with appropriate antibiotic therapy, regardless of abscess size, as this approach allows for continued breastfeeding and avoids cosmetic damage. 1

Diagnostic Approach

• Ultrasound examination is essential for confirming diagnosis and guiding treatment
• Collect samples of milk or abscess material for microbiological testing to guide antibiotic therapy

Treatment Algorithm

First-Line Treatment

1. Needle aspiration

   • Preferred approach for abscesses of all sizes 1
   • May require multiple aspiration sessions (average 2.4 aspirations) 2
   • Can be performed as an outpatient procedure
   • Allows for continued breastfeeding

2. Concurrent antibiotic therapy

   • Amoxicillin-clavulanate 875/125 mg PO twice daily is typically recommended 3
   • Adjust based on culture results, especially if MRSA is identified 1
   • Continue antibiotics for 7-10 days

Alternative Approaches Based on Abscess Characteristics

1. For larger abscesses (>3 cm)

   • Consider ultrasound-guided percutaneous catheter placement 4
   • May be more effective than repeated needle aspirations for larger collections

2. Surgical incision and drainage should be reserved for:

   • Very large abscesses (>5 cm) that fail needle aspiration
   • Multiloculated abscesses
   • Long-standing abscesses
   • Cases where percutaneous drainage is unsuccessful 3

3. For breastfeeding mothers with mastitis/abscess

   • Continue breastfeeding or milk expression from the affected breast 5
   • Ensure the infant's mouth does not contact purulent drainage
   • Regular feeding or expression is an adjunct to other treatments 5

Effectiveness of Conservative Management

Research demonstrates high success rates with conservative management:

• 71.9% of patients successfully treated with needle aspiration and antibiotics in a 2022 study 1
• 90.5% (19/21) of non-lactational breast abscesses successfully treated by needle aspiration and antibiotics 2
• Conservative management allows 40.6% of women to continue breastfeeding beyond 6 months 1

Advantages of Needle Aspiration over Surgical Drainage

1. Outpatient procedure requiring no hospitalization
2. No general anesthesia required
3. Superior cosmetic results
4. Shorter healing time
5. Easily repeatable if needed
6. Lower risk of recurrences (no interruption of milk ducts)
7. Less painful
8. Allows immediate return to breastfeeding 1

Follow-up Care

• Re-evaluate within 48-72 hours to assess healing progress
• Repeat ultrasound to confirm resolution
• Consider additional aspirations if fluid reaccumulates
• For recurrent subareolar abscesses and fistulas, refer for consideration of surgical treatment 3

Common Pitfalls to Avoid

1. Inadequate drainage can lead to recurrence
2. Premature cessation of breastfeeding - breastfeeding should continue as it helps in resolution
3. Failure to obtain cultures before starting antibiotics
4. Inappropriate antibiotic selection not covering potential MRSA
5. Missing underlying malignancy - persistent or recurrent abscesses should prompt further investigation

The evidence strongly supports a conservative approach to breast abscess management, with needle aspiration and appropriate antibiotics being highly effective while preserving breast function and cosmesis.