What is the treatment for a superficial abscess on the breast?

Treatment of Superficial Breast Abscess

The primary treatment for a superficial abscess on the breast is incision and drainage, with antibiotics generally unnecessary unless there are signs of systemic infection. 1, 2

Initial Management

• Incision and drainage (I&D) is the cornerstone of treatment for superficial breast abscesses 1, 2
• The procedure involves opening the abscess, evacuating the infected material, and continuing dressing changes until the wound heals by secondary intention 1
• For simple abscesses with minimal surrounding erythema (<5 cm) and minimal systemic signs of infection (temperature <38.5°C, pulse <100 beats/min), antibiotics are unnecessary 1, 2
• Cultures of the abscess material should be obtained during drainage to guide therapy if antibiotics become necessary 1

Antibiotic Considerations

• Antibiotics should be added to I&D only if specific criteria are met 1:

  • Presence of systemic inflammatory response syndrome (SIRS): temperature >38°C or <36°C, tachypnea >24 breaths/minute, tachycardia >90 beats/minute, or abnormal white blood cell count
  • Erythema extending >5 cm beyond the wound margins
  • Immunocompromised patient
  • Incomplete source control after drainage

• If antibiotics are indicated, empiric therapy should target Staphylococcus aureus (including MRSA consideration) and streptococcal species, which are the most common pathogens in breast abscesses 1

Alternative Drainage Techniques

• Ultrasound-guided needle aspiration is an effective alternative to traditional I&D, particularly for lactational breast abscesses 3, 4
• Benefits of needle aspiration include:
  • Can be performed under local anesthesia as an outpatient procedure 3, 4
  • Excellent cosmetic results with no scarring 3
  • Can be repeated if necessary 4
  • Less painful than traditional I&D 4

Post-Procedure Care

• Warm soaks and appropriate wound care with dressing changes until healing occurs 5
• Ensure adequate drainage with wicks or drains if needed 5
• Close follow-up to monitor healing progress 5

Common Pitfalls to Avoid

• Failing to differentiate between simple and complex abscesses, which require different management approaches 2
• Prescribing antibiotics for simple abscesses when not indicated, which provides no clinical benefit and contributes to antibiotic resistance 1, 2
• Inadequate drainage leading to recurrence or persistent infection 5
• Failure to make an appropriately sized incision that allows complete drainage 5

Special Considerations

• For large abscesses, consider multiple counter incisions rather than a single long incision to prevent step-off deformity and delayed wound healing 2
• If the patient has significant systemic symptoms, consider hospital admission for intravenous antibiotics and more aggressive management 1, 2
• For recurrent abscesses, evaluate for underlying conditions such as hidradenitis suppurativa or foreign material 1