What is the treatment for breast abscess?

From the Guidelines

Breast abscess treatment should primarily involve incision and drainage, with antibiotic therapy considered for severe or extensive disease, or when there are signs of systemic illness, according to the guidelines by the Infectious Diseases Society of America 1.

Key Considerations

• The primary treatment for a cutaneous abscess, including breast abscess, is incision and drainage, as stated in the guidelines 1.
• Antibiotic therapy is recommended for abscesses associated with severe or extensive disease, rapid progression, signs and symptoms of systemic illness, or lack of response to incision and drainage alone 1.
• For empirical coverage of CA-MRSA in outpatients with SSTI, oral antibiotic options include clindamycin, TMP-SMX, a tetracycline, and linezolid 1.

Treatment Approach

• Incision and drainage should be performed, either through needle aspiration or surgical incision and drainage, depending on the size and complexity of the abscess.
• Antibiotic therapy should be considered based on the severity of the disease and the presence of systemic illness, with options including clindamycin, TMP-SMX, and linezolid.
• Warm compresses and pain management with acetaminophen or ibuprofen should be applied to the affected area.
• Breastfeeding mothers should continue nursing or expressing milk from the affected breast to prevent milk stasis.

Important Notes

• Cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1.
• The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended 1.

From the Research

Breast Abscess Treatment Options

• Incision and drainage: This traditional method involves surgically draining the abscess, often under general anesthesia 2.
• Needle aspiration: This method involves using a needle to drain the abscess, often under local anesthesia and with antibiotic coverage 2, 3, 4, 5.
• Ultrasound-guided aspiration: This method uses ultrasound to guide the needle and drain the abscess, often in an outpatient setting 3, 4, 6.
• Ultrasound-guided aspiration and irrigation: This method involves using ultrasound to guide the needle and drain the abscess, followed by irrigation to clean the area 3.

Effectiveness of Treatment Options

• Ultrasound-guided aspiration has been shown to be an effective treatment for breast abscesses, with cure rates ranging from 82% to 97.7% 3, 4, 5, 6.
• Needle aspiration without ultrasound guidance has also been shown to be effective, with an overall cure rate of 82% 5.
• Incision and drainage has been compared to needle aspiration, with results showing that needle aspiration may be a better treatment modality 2.
• The effectiveness of ultrasound-guided aspiration is not significantly different for abscesses caused by methicillin-resistant or methicillin-sensitive Staphylococcus aureus infection 6.

Factors Affecting Treatment Success

• Abscess size and volume: Smaller abscesses may be more effectively treated with needle aspiration 5.
• Multiloculated lesions: These may be more difficult to treat with needle aspiration, and may require incision and drainage 4.
• Patient presentation: Patients who present earlier may be more likely to be successfully treated with needle aspiration 5.
• Antibiotic utilization: The use of antibiotics may be necessary in some cases, particularly for abscesses caused by bacterial infection 6.