Breast abscess: evidence based management recommendations

Abstract

Literature review was carried out and studies reporting on treatment of breast abscesses were critically appraised for quality and their level of evidence using the Strength of Recommendation Taxonomy guidelines, and key recommendations were summarized. Needle aspiration either with or without ultrasound guidance should be employed as first line treatment of breast abscesses. This approach has the potential benefits of: superior cosmesis, shorter healing time, and avoidance of general anaesthesia. Multiple aspiration sessions may be required for cure. Ultrasound-guided percutaneous catheter placement may be considered as an alternative approach for treatment of larger abscesses (>3 cm). Surgical incision and drainage should be considered for first line therapy in large (>5 cm), multiloculated, or long standing abscesses, or if percutaneous drainage is unsuccessful. All patients should be treated concurrently with antibiotics. Patients with recurrent subareolar abscesses and fistulas should be referred for consideration of surgical treatment.

Keywords::

• breast abscess
• breast infection
• incision and drainage
• mastitis
• percutaneous drainage

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• All breast abscesses should be treated with abscess drainage and concurrent empiric antibiotic therapy.

• Needle aspiration either with or without ultrasound guidance should be employed as first-line treatment of breast abscesses. However, multiple aspiration sessions may be required.

• Ultrasound-guided percutaneous catheter placement may be considered as an alternative approach for drainage of larger (>3 cm) abscesses.

• Surgical incision and drainage is required if needle aspiration or catheter drainage is unsuccessful and there is progression of infection.

• Surgical incision and drainage should be considered for first-line therapy of large (>5 cm), multiloculated or long-standing breast abscesses.

• Cultures should be obtained at the time of abscess drainage and antibiotic management tailored to the infecting organism’s susceptibility profile.

• Empiric antibiotics targeting methicillin-resistant S. aureus may be required for patients who are known to be colonized or considered to be at high risk.

• For breastfeeding women, the infant should not nurse from the breast with the abscess but may continue nursing from the contralateral, uninfected breast.

• Future research should prospectively evaluate the utilization of aspiration or percutaneous catheter drainage techniques in terms of frequency of progression of infection requiring surgical management in order to limit selection biases. The optimal frequency of aspirations, time interval between aspirations and duration of catheter placement also requires further study.