From the Research
Management of breast necrosis requires prompt surgical debridement, broad-spectrum antibiotic therapy, and supportive care to prevent morbidity and mortality. The treatment approach should be multifaceted, considering the extent and severity of tissue damage. Initial treatment involves surgical debridement of necrotic tissue to remove dead cells and prevent further infection, as emphasized in a recent case series and review of the literature 1. This should be followed by appropriate wound care, including regular dressing changes with antimicrobial dressings such as silver-containing products or iodine-based solutions.
Systemic antibiotics are often necessary, with empiric therapy using broad-spectrum agents such as piperacillin-tazobactam, as recommended in a review of antibiotic use in necrotizing soft tissue infections 2. Adjustments to antibiotic therapy should be based on culture results, taking into account the potential for multidrug-resistant organisms. Pain management using acetaminophen, NSAIDs, or opioids as needed is important for patient comfort. For extensive necrosis, hyperbaric oxygen therapy may accelerate healing by increasing tissue oxygenation, although its use should be considered on a case-by-case basis.
Nutritional support is crucial, with emphasis on protein intake (1.2-1.5 g/kg/day) and vitamin C supplementation (500-1000 mg daily) to support tissue repair. In severe cases, reconstructive surgery may be necessary after the acute phase resolves. Throughout treatment, regular monitoring for signs of systemic infection is essential, as breast necrosis can lead to sepsis if inadequately managed. The underlying cause of necrosis, such as radiation, surgery complications, or infection, should also be addressed to prevent recurrence, as highlighted in a review of necrotizing fasciitis of the breast 3.
Key considerations in the management of breast necrosis include:
- Prompt recognition and diagnosis to initiate timely treatment
- Aggressive surgical debridement to remove necrotic tissue
- Broad-spectrum antibiotic therapy, with adjustments based on culture results
- Supportive care, including pain management, nutritional support, and wound care
- Monitoring for signs of systemic infection and addressing the underlying cause of necrosis to prevent recurrence.