What is the recommended treatment for a breast abscess in a lactating mother?

Treatment of Breast Abscesses in Lactating Mothers

The recommended treatment for breast abscesses in lactating mothers includes drainage of the abscess (either by needle aspiration or catheter drainage depending on size) along with continued breastfeeding and appropriate antibiotics. 1, 2

Diagnosis and Initial Approach

• Breast abscesses typically develop as a complication of lactational mastitis, with an incidence ranging from 0.4 to 11% of all lactating mothers 2
• Diagnosis is typically based on clinical presentation (inflammatory swelling, pain) and confirmed with ultrasound, which is the first-line imaging modality for lactating women 1, 3
• Ultrasound has the highest sensitivity for diagnosis in the setting of a palpable mass with nearly 100% sensitivity reported in many studies 1

Treatment Options

Drainage Procedures

• For abscesses smaller than 3 cm in diameter:

  • Ultrasound-guided needle aspiration is recommended as first-line treatment 4, 5
  • May require multiple aspirations (in approximately 45% of cases) 6
  • Provides excellent cosmetic results and allows continued breastfeeding 2, 4

• For abscesses 3 cm or larger in diameter:

  • Ultrasound-guided catheter drainage is recommended 4, 5
  • Well-tolerated by patients with minimal pain (mean pain score 2.3 on a scale of 0-10) 4
  • Allows for continuous drainage of larger collections 5

• Surgical incision and drainage:

  • Should be reserved for cases where needle aspiration or catheter drainage fails 6
  • May be necessary for abscesses larger than 5 cm or with unusually large volumes of pus 6
  • Associated with longer healing time, regular dressings, and less satisfactory cosmetic outcomes 2

Antibiotic Therapy

• Antistaphylococcal antibiotics should be prescribed as Staphylococcus aureus is the most commonly isolated organism (found in approximately 79.5% of cases) 3
• Safe antibiotics during lactation include penicillins, cephalosporins, and erythromycin 2
• Antibiotics should be started promptly when mastitis is diagnosed to prevent progression to abscess formation 3

Continued Breastfeeding

• Mothers with breast abscesses are encouraged to continue breastfeeding 1
• Regular feeding or expression of milk is an important adjunct to other treatments 1
• Breastfeeding can continue on the affected side as long as the infant's mouth does not contact purulent drainage from the breast 1
• If direct breastfeeding is too painful, expressing milk from the affected breast helps maintain milk supply and prevent stasis 1

Follow-up and Complications

• Ultrasound follow-up is recommended to ensure complete resolution of the abscess 5
• Potential complications include:
  • Recurrence (reported in approximately 4% of cases) 5
  • Milk fistula formation 2
  • Prolonged healing time if not properly managed 2

Prevention

• Prevention of abscesses during lactation focuses on:
  • Improving breastfeeding practices to prevent nipple trauma 3
  • Early antibiotic treatment of mastitis 3
  • Regular and complete emptying of the breast 1

Special Considerations

• If a mass persists after drainage, further investigation with fine-needle aspiration cytology or biopsy may be needed to rule out underlying malignancy 5
• For women over 30 years old with breast abscesses, mammography may be considered after resolution of the acute infection 5