Surgery without knife: an ideal treatment for lactational breast abscess

Abstract

INTRODUCTIONBreast abscess is common in lactating females. The incidence of breast abscess ranges from 0.4 to 11% of all lactating mothers.1 Risk factors for the development of breast abscess are milk stasis by duct blockage, stress, sore nipples or infrequent breastfeeding. Other risk factors for abscess formation include maternal age over 30 years, gestational age greater than 41 weeks and a history of mastitis. The pathogen most commonly Staphylococcus aureus enter into breast via cracked nipple specially in primipara due to inexperience, poor feeding technique and poor attachment by baby.2 Breast abscess is common in developing countries due to poor maternal hygiene, decreased nutrition, poor standard of living, delay in antibiotics administration and poor breastfeeding techniques. Patient having breast abscess presents with symptoms of pain, swelling and redness of the involved breast. There may be associated fever, malaise and occasionally rigors.Traditional treatment of breast abscesses is by surgical incision and drainage which is followed by digital disruption of septa, evacuation of contents with occasional placement of surgical drains.Recently ultrasound guided aspiration has been tried for treatment of breast abscesses where a thick needle, preferably 16G, is inserted into the abscess cavity and contents are aspirated until the cavity is collapsed. Breast abscess being a common problem needs further evaluation for its definitive treatment.To go for conventional yet definitive form that is incision and drainage or to go for ultrasound guided aspiration is the question which still needs answering. ABSTRACTBackground: Incidence of breast abscess is 0.4 to 11% of all lactating mothers. Traditionally the treatment of breast abscess has been incision and drainage. Recently aspiration under ultrasound guidance is emerging as another treatment option and rapidly replace incision and drainage Methods: Authors carried out a prospective, randomized study involving 50 lactating women with breast abscess. In group A -25 patients were managed by ultrasound guided needle aspiration and in group B -25 patients were managed by incision and drainage. Results: In patients of group A, most breast abscesses resolved with one or two aspirations only, with early healing and lesser number of hospital visits as compared to patients in group B. There was no surgical scar and early resumption of breastfeeding was seen in group A. Conclusions: Ultrasound guided percutaneous aspiration is an effective modality of treatment of lactational breast abscess and it should be the first line of treatment, especially for smaller and unilocular breast abscesses while incision and drainage should be reserved for larger and multilocular abscesses with imminent skin changes.

The effectiveness of needle aspiration versus traditional incision and drainage in the treatment of breast abscess: a meta-analysis

“…Ultrasound guidance was used in the NA group in six trials [ 19–23 , 25 ]. Four included trials [ 1 , 19 , 20 , 23 ] mentioned the analysis of pathogens causing breast abscesses and found that the predominant pathogen was Staphylococcus aureus . In eight trials [ 1 , 19–23 , 25 , 26 ] patients were simultaneously treated with antibiotics.…”

“…Breast fistula was the most frequently reported complication of breast abscess, especially in puerperal patients, and the incidence of breast fistula was extracted from five included trials [ 19 , 22 , 23 , 25 , 26 ]. All patients included in these studies were puerperal abscesses and heterogeneity between the included trials was low ( I 2 = 0%, p = .994).…”