Lam E, Chan T, Wiseman SM. Breast abscess: evidence based management recommendations. Expert Rev Anti Infect Ther. 2014 Jul;12(7):753-62.

Full-text for Emory users.

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.

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“Our comprehensive literature review has revealed that there is a lack of high-quality randomized trials that demonstrated the superiority of one treatment plan over another, which leads to multiple management options that are left to the discretion of the managing physician. Lactational and nonlactational breast abscesses are two distinct clinical entities, each with a discrete pathogenesis, though their initial management is currently the same.”

Naeem M, Rahimnajjad MK, Rahimnajjad NA, et al. Comparison of incision and drainage against needle aspiration for the treatment of breast abscess. Am Surg. 2012 Nov;78(11):1224-7. Full-text for Emory users.

Rao R, Ludwig K, Bailey L, et al. Select Choices in Benign Breast Disease: An Initiative of the American Society of Breast Surgeons for the American Board of Internal Medicine Choosing Wisely® Campaign. Ann Surg Oncol. 2018 Oct;25(10):2795-2800. Full-text for Emory users.

Trop I, Dugas A, David J, et al. Breast abscesses: evidence-based algorithms for diagnosis, management, and follow-up. Radiographics. 2011 Oct;31(6):1683-99. Full-text for Emory users.