From the Guidelines
Breast abscesses should be treated with incision and drainage as the primary treatment, with antibiotic therapy added in cases of severe or extensive disease, or when there are signs of systemic illness, according to the guidelines by the Infectious Diseases Society of America 1.
Treatment Approach
The treatment of breast abscesses involves:
- Incision and drainage, which is the primary treatment for cutaneous abscesses, including breast abscesses 1
- Antibiotic therapy, which is recommended for abscesses associated with severe or extensive disease, rapid progression, signs of systemic illness, or lack of response to incision and drainage alone 1
Antibiotic Options
For empirical coverage of CA-MRSA in outpatients with skin and soft tissue infections (SSTIs), including breast abscesses, oral antibiotic options include:
- Clindamycin 1
- Trimethoprim-sulfamethoxazole (TMP-SMX) 1
- A tetracycline (doxycycline or minocycline) 1
- Linezolid 1
Special Considerations
- Breastfeeding mothers should continue nursing from the unaffected breast and can resume nursing from the affected breast once drainage is complete and pain improves
- Warm compresses applied to the affected area for 15 minutes several times daily can help with pain relief and promote healing
- Recurrent abscesses may indicate underlying conditions requiring further investigation, including mammography or ultrasound to rule out inflammatory breast cancer or other pathologies
- Proper hygiene, complete treatment courses, and addressing predisposing factors like cracked nipples can help prevent recurrence
Key Points
- Incision and drainage is the primary treatment for breast abscesses
- Antibiotic therapy should be added in cases of severe or extensive disease, or when there are signs of systemic illness
- Empirical coverage of CA-MRSA is recommended for outpatients with SSTIs, including breast abscesses
- Breastfeeding mothers can continue nursing from the unaffected breast and resume nursing from the affected breast once drainage is complete and pain improves
From the Research
Definition and Prevalence of Breast Abscess
- Breast abscesses are a common reason for females to seek surgical consultation, affecting women of all ages and associated with significant morbidity 2.
- The prevalence of breast abscesses is notable, with studies indicating that they remain one of the most common reasons for females to come for a surgical consult 3.
Causes and Microbiology of Breast Abscess
- The main causative organism in breast abscesses is Staphylococcus aureus, with a significant proportion being methicillin-resistant Staphylococcus aureus (MRSA) 3.
- Other organisms that can cause breast abscesses include Klebsiella pneumoniae, Bacteroides, Pseudomonas, Streptococcus species, and Mycobacterium tuberculosis 3.
Diagnosis and Treatment of Breast Abscess
- Diagnosis of breast abscesses can be made using ultrasonography (US), and material obtained using US-guided fine needle aspiration (FNA) can be further examined 4.
- Treatment options for breast abscesses include:
- Needle aspiration, either with or without ultrasound guidance, as first-line treatment 5.
- Ultrasound-guided percutaneous catheter placement as an alternative approach for larger abscesses (>3 cm) 5.
- Surgical incision and drainage for large (>5 cm), multiloculated, or long-standing abscesses, or if percutaneous drainage is unsuccessful 5.
- Antibiotic therapy, with consideration of institutional antibiogram-targeted treatment and empirical therapy with ciprofloxacin and clindamycin 3.
Management and Follow-up of Breast Abscess
- An evidence-based algorithm for management of breast abscesses has been developed, which includes diagnosis, management, and follow-up 6.
- Radiologists have a pivotal role in the evaluation and follow-up of breast abscesses, and a multidisciplinary team approach can be effective in managing these lesions 6.
- There is a lack of randomized-controlled trials focused on the treatment of breast infections, resulting in variable practice patterns and a need for the development of best-care protocols or pathways 2.