What are the options for emergency department (ED) treatment of breast abscess?

Updated: Jul 27, 2020
  • Author: Andrew C Miller, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

Historically, incision and drainage was considered the standard of care for abscesses. Although this method yields a lower reoccurrence rate, it is more invasive than needle aspiration and frequently results in scarring with structural damage and poor cosmetic outcomes. [62] Fine-needle aspiration should be considered first-line therapy for abscesses smaller than 5 cm owing to its lower risks, followed by incision and drainage if recurrence occurs. [4] Although success has been reported with oral antistaphylococcal antibiotics and serial aspiration, [74] surgical excision may be required for infected or obstructed lactiferous ducts and provides a lower rate of recurrence for nonpuerperal abscess and mastitis. [63, 8]

For persistent lesions, treatment options may include ultrasound-guided needle aspiration, [20] percutaneous drainage catheter, [70, 70] and/or surgical drainage. Ultrasound-guided needle aspirations are more successful for abscesses smaller than 3 cm and for puerperal abscesses. [64, 65, 66, 8, 75] Loculations are associated with failure of resolution with aspiration, regardless of abscess volume. [67] Nonpuerperal abscesses have a higher recurrence rate and often require multiple drainage attempts. [8] Regardless of the underlying organism, the need for repeat aspiration is common in patients treated with aspiration versus incision and drainage. [68] In a US cohort of 54 abscess cases treated with needle-guided aspiration, the median number of drainage procedures was 2 (interquartile range, 1.0-4.0), with 24% requiring 5 or more drainage procedures. [38]

The vacuum-assisted breast biopsy (VABB) system is a viable option for the management of lactational breast abscesses and has been associated with a shorter healing time than simple needle aspiration. [69, 76] ​ Furthermore, percutaneous catheter drainage may be considered for larger abscesses. [4, 70]


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