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ORIGINAL ARTICLE
Year : 2012  |  Volume : 26  |  Issue : 3  |  Page : 189-191

Management of breast abscess by repeated aspiration and antibiotics


Department of Surgery, RIMS, Imphal, Manipur, India

Date of Web Publication10-Jun-2013

Correspondence Address:
Gojen Singh
Department of Surgery, RIMS, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958 .113249

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  Abstract 

Objective: The aim of this study is to avoid psychological distress to the mother and baby by avoiding General Anaesthesia and overnight hospital stay which will be required, if the abscess is to be drained by incision drainage and to avoid leaving an ugly scar on the breast. Materials and Methods: In our prospective study, 50 patients with breast abscesses were treated by needle aspiration of pus, oral antibiotics, and repeat aspiration, if necessary. All were outpatients, and treated in Department of Surgery, Regional Institute of Medical Sciences, Imphal. Ultrasonography was not used. Out of 50 patients, 31 were lactating mothers. Results: The mean age of the patient was 32 years (19-80 years). Staphylococcus aureus was the most common organism isolated in both lactating and non lactating cases. Of the 50 cases, 39 (78%) resolved well without recurrence. Eight (16%) cases failed to respond to repeated aspiration and underwent incision and drainage. Three (6%) cases had recurrent abscess occurring 1 month after the last aspiration. Conclusion: Needle aspiration with antibiotic is an effective treatment for breast abscesses.

Keywords: Breast abscess, Lactating, Needle aspiration


How to cite this article:
Singh G, Singh G, Singh L R, Singh R, Singh S, Sharma K L. Management of breast abscess by repeated aspiration and antibiotics. J Med Soc 2012;26:189-91

How to cite this URL:
Singh G, Singh G, Singh L R, Singh R, Singh S, Sharma K L. Management of breast abscess by repeated aspiration and antibiotics. J Med Soc [serial online] 2012 [cited 2020 Oct 31];26:189-91. Available from: https://www.jmedsoc.org/text.asp?2012/26/3/189/113249


  Introduction Top


Breast abscess is defined as an acute inflammatory lump which yields pus on incision/aspiration. [1] It is a common staphylococcal soft tissue infection which is characterized by localized pain, swelling, and redness associated with a mass that may or may not be fluctuant. [2] Lactational breast abscess occurring during breast feeding is the result of Staphylococcus infection. Such abscesses tend to occur at the commencement of breast feeding when an inexperienced mother developed cracked nipples. They also occur at weaning when engorgement results from incomplete drainage of breast milk. Non-lactational breast abscesses are entirely different from those occurring during breast feeding. They occur in the peri-areolar tissues, frequently recur, and infecting organisms are a mixture of bacteroides, anaerobic streptococci, and enterococci. Such non-lactational breast abscess is a manifestation of duct ectasia/periductal mastitis and is usually seen in the age group 30-60 years. When the breast infection is seen prior to frank abscess formation, antibiotic treatment alone is successful. If, on aspiration, pus is found or other systemic features of an abscess are present drainage is necessary. However, some recent authorities have recommended repeated daily aspiration under antibiotic coverage. [3]

The present work tries to study the treatment of breast abscess by repeated aspiration and antibiotic.


  Materials and Methods Top


The study group comprises of 50 patients with breast abscess who attended the Outpatient Department (OPD) of surgery, Regional Institute of Medical Sciences (RIMS), Imphal during the period of May 2005 to April 2007. Of these, 31 patients (62%) were lactating and 19 patients (38%) were non-lactating. The diagnosis of the abscess was made when there was redness, warmth, tenderness, and swelling in the breast. The procedures performed were in accordance with the ethical standards of the Institute. Initial treatment comprised of aspirating as much as possible from the abscess with a 16 G to 19 G needle with 10 ml syringe and a 7 days course of oral ampicillin and cloxacillin 500 mg 3 times daily. The procedure was performed in the surgery OPD. Ultrasound guidance was not used for any patient. Sample of pus from all 50 patients were sent to the Department of Microbiology, RIMS for culture and sensitivity. If the abscess has not resolved after repeated aspiration, this was accepted as treatment failure. Incision and drainage was performed when there was failure of non-operative treatment as indicated by a lack of improvement in clinical sign of infection or in the amount of pus aspirated after a number of follow-up reviews or when the pus was too thick to aspirate. The following information was recorded in a database for each patient: Age, parity, location, duration of lactation and symptoms, result of pus culture, healing time, recurrent, pus volume removed, and number of aspiration performed.

Lactating patients were encouraged to continue breast feeding from the unaffected breast and the breast with abscess was emptied by means of a pump to prevent milk stasis. Follow-up was performed in all cases twice weekly until clinical signs of abscess had resolved following which the patients were reviewed after 3 weeks and 3 months for recurrence.


  Results and Observation Top


The mean age of the 50 patients was 32 years (range: 19-80 years, [Table 1]) with 31 patients (62%) were lactating and 19 (38%) were non-lactating. Twenty nine (58%) patients presented with fever. In 16 (32%) patients abscess occurred at the peri-areolar region while in 34 (68%) at the periphery of the breast [Table 2]. Forty (80%) patients positive culture with Staphylococcus aureus in 32 (64%),  Escherichia More Details coli in 4 (8%), Klebsiella in 3 (6%) and Pseudomonas in 1 (2%). Ten (20%) patients yielded a sterile bacteriologic culture [Table 3].
Table 1: Distribution of age

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Table 2: Topography of breast abscesses

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Table 3: Bacteriology of pus from 50 patients (both lactational and non-lactational) with breast abscess

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Out of the 50 cases studied, majority of the patients i.e., 25 (50%) presented with breast abscesses in the upper outer quadrant. Ipsilateral axillary lymph node enlargement was seen in 4 (8%) patients only. Thirty nine (78%) of the 50 cases had size of the abscess 4 cm and 11 (22%) cases had size > 4 cm. All the cases were subjected to needle aspiration and antibiotic therapy. There was no treatment failure when size of the abscess was 4 cm. However, there was failure of treatment in 7 out 11 cases who had size > 4 cm. The average initial volume of pus aspirated was 17.1 ml (range 0.2-100 ml). The mean number of aspiration required was 3 (range 1-5). Of the 50 cases, 39 (78%) resolved well without recurrence. Eight (16%) cases failed to respond to repeated aspiration and underwent incision and drainage. Three (6%) cases had recurrent abscess occurring 1 month after the last aspiration. All three recurrences were at the site of the previous abscess. On follow-up, most of the patients on whom aspiration was successful were completely satisfied with the treatment psychologically as there was no separation from the baby during the treatment. On the other hand, those treated with incision and drainage was psychologically disturbed.


  Discussion Top


Lactational breast abscesses are more common than non-lactational breast abscesses. In our study of 50 cases, 31 (62%) cases were lactational and 19 (38%) cases were non-lactational breast abscesses which is comparable with the findings in the series of Schwarz et al. [4] with 83% (lactational) and 17% (non-lactational). However, Elagili et al. [5] reported 53.3% of non-lactational and 46.7% of lactational in his study. The mean age of our patients was 32 years (range: 19-80 years) which is consistent with the finding of Elagili et al. [5] and Ulitzsch et al. [6] with the mean age of 31.93 years and 32 years in lactational and non-lactational cases. S. aureus was the most common pathogen isolated in this study in 32 (64%) cases which is comparable with findings by Elagili et al., [5] Ulitzsch et al. [6] and Dixon et al. [7] Of the 50 patients aspirated in our study, 39 (78%) resolved well without recurrence, 8 (16%) cases failed to repeated aspiration and underwent incision and drainage and 3 (6%) cases had recurrent abscess occurring 1 month after the last aspiration. The success rate by needle aspiration without resorting to surgical drainage was 84%. These findings were in consistent with the reports of Schwarz et al. [4] and Hansen et al. [8] On follow-up, most of the patients on whom aspiration was successfully done were satisfied with the treatment psychologically as there was no separation from the baby during the treatment. On the other hand, those treated with incision and drainage was psychologically disturbed. Forty two patients who underwent needle aspiration have no scar and were cosmetically acceptable but eight patients who underwent incision and drainage had ugly scars. Similar outcomes of good cosmesis after needle aspiration of breast abscess were reported by Schwarz et al. [4] Dixon et al. [7] Elagili et al. [5] Eryilmaz et al. [9] and Karstrup et al. [10]


  Conclusion Top


Breast abscess still remains a common problem especially, for lactating mother and their babies who require continued breast feeding. In the past, most patients with a lactating abscess have been treated by incision and drainage of the abscess under general anesthesia. These may cause considerable distress to both the mother and baby and the final cosmetic result is often unsatisfactory. Now, majority of the breast abscess can be effectively treated without surgery on an outpatient basis, by a combination of needle aspiration and antibiotics with a cosmetic satisfaction. With similar reports from various centers, this technique should become the standard practice in the management of breast abscess.

 
  References Top

1.Scholefield JH, Duncan JL, Rogers K. Review of a hospital experience of breast abscesses. Br J Surg 1987;74:469-70.  Back to cited text no. 1
    
2.Garrison RN, Fry DE. Surgical infection. In: Lawrence PF, editor. Essential of General Surgery. 3 rd ed. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 123-39.  Back to cited text no. 2
    
3.Greennal MJ. Benign conditions of breast. In: Morris PJ, Malt RA, editors. Oxford Text Book of Surgery. New York: Oxford University Press; 1994. p. 789-808.  Back to cited text no. 3
    
4.Schwarz RJ, Shrestha R. Needle aspiration of breast abscesses. Am J Surg 2001;182:117-9.  Back to cited text no. 4
    
5.Elagili F, Abdullah N, Fong L, Pei T. Aspiration of breast abscess under ultrasound guidance: Outcome obtained and factors affecting success. Asian J Surg 2007;30:40-4.  Back to cited text no. 5
    
6.Ulitzsch D, Nyman MK, Carlson RA. Breast abscess in lactating women: US-guided treatment. Radiology 2004;232:904-9.  Back to cited text no. 6
    
7.Dixon JM. Outpatient treatment of non-lactational breast abscesses. Br J Surg 1992;79:56-7.  Back to cited text no. 7
    
8.Hansen PB, Axelsson CK. Treatment of breast abscess. An analysis of patient material and implementation of recommendations. Ugeskr Laeger 2003;165:128-31.  Back to cited text no. 8
    
9.Eryilmaz R, Sahin M, Hakan Tekelioglu M, Daldal E. Management of lactational breast abscesses. Breast 2005;14:375-9.  Back to cited text no. 9
    
10.Karstrup S, Nolsøe C, Brabrand K, Nielsen KR. Ultrasonically guided percutaneous drainage of breast abscesses. Acta Radiol 1990;31:157-9.  Back to cited text no. 10
    



 
 
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