Treatment of Breast Abscesses with Sonographically Guided Aspiration, Irrigation, and Instillation of Antibiotics

Leborgne, Félix

doi:10.2214/ajr.181.4.1811089

Cited by 44 publications

(43 citation statements)

References 15 publications

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“…Alphonce et al [11] observed cure rate of 93.1% in ultrasound guided aspiration. In our study recurrence rate of USG guided aspiration was 12% which correlates with study conducted by Francisco Leborgne et al [13]. Out of 25 patients managed by incision and drainage one patients 4% developed recurrent breast abscess within four months of primary surgery The mean healing time in USG guided aspiration group was 15.5 days while in incision-drainage group was 24.4 days.…”

Section: Discussionsupporting

confidence: 88%

To Compare the Results of Ultrasound Guided Aspiration and Incision and Drainage in the Management of Breast Abscess

Manoharan¹,

Venkatesh²,

Shanmugam³

2016

SJAMS

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Breast abscess is less common in developed countries due to improved puerperal hygiene, nutrition, early administration of antibiotics and standard of living, breast abscess remains a morbid condition among lactating women in developing countries. Breast abscess is a most common cause of morbidity in puerperal women. Breast abscess ranges from mastitis to deep abscess. The Incidence of lactation breast abscess is high in India. The aim of this study is to compare the results of ultrasound guided aspiration and incision and drainage in the management of breast abscess. This is a comparative study between ultrasound guided aspiration and incision and drainage consist of 50 patients who underwent both the treatment alternatively. Even though recurrence rate is slightly high in USG guided aspiration when compared to incision and drainage, USG guided aspiration is effective method of treatment in breast abscess with good patient satisfaction. Even though recurrence rate is slightly high in USG guided aspiration when compared to incision and drainage, USG guided aspiration is effective method of treatment in breast abscess with good patient satisfaction.

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Section: Discussionsupporting

confidence: 88%

To Compare the Results of Ultrasound Guided Aspiration and Incision and Drainage in the Management of Breast Abscess

Manoharan¹,

Venkatesh²,

Shanmugam³

2016

SJAMS

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“…Abscesses that are multiloculated or larger than 3 cm in diameter may fail ultrasound-guided drainage; thus, in such instances, early surgical evaluation for incision and drainage is strongly recommended [4]. In addition to ultrasound-guided drainage, all suspected breast abscesses should be managed with antibiotics including cloxacillin 500 mg four times daily, clindamycin 300 mg four times daily, erythromycin 500 mg three times daily, or cefazolin 500 mg four times daily for a total of 7-10 days [4,5]. Breast feeding should be continued throughout the treatment period and only discontinued when using antibiotics that are contraindicated for newborns (ciprofloxacin, tetracycline, or chloramphenicol), or if surgical incision and drainage is completed [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to ultrasound-guided drainage, all suspected breast abscesses should be managed with antibiotics including cloxacillin 500 mg four times daily, clindamycin 300 mg four times daily, erythromycin 500 mg three times daily, or cefazolin 500 mg four times daily for a total of 7-10 days [4,5]. Breast feeding should be continued throughout the treatment period and only discontinued when using antibiotics that are contraindicated for newborns (ciprofloxacin, tetracycline, or chloramphenicol), or if surgical incision and drainage is completed [4,5]. In the rare cases in which breast abscess is clinically suspected, but initial ultrasound fails to demonstrate a defined fluid collection, evaluation for inflammatory carcinoma should be completed with mammography or breast biopsy [6].…”

Section: Discussionmentioning

confidence: 99%

Emergency management of puerperal breast abscess

Chauhan

Polen

2012

Intern Emerg Med

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A 38-year-old woman, who was 1 month postpartum, presented with left breast pain. The patient reported a 5-day history of stabbing left breast pain, erythema, and tenderness. She had been breast feeding and pumping breast milk without difficulty, but recently noted blood, mucous, and purulent material within the pumped milk. The patient denied fevers, chills, breast trauma, a palpable mass, or right breast abnormalities. Ultrasound of the left breast demonstrated a 4.7 9 2.1 cm complex fluid collection with associated skin thickening, consistent with left breast cellulitis, mastitis, and a breast abscess (Fig. 1). Surgical consultation was obtained, and a trial of ultrasound-guided aspiration of the left breast abscess was completed (Fig. 2) that yielded 12 ml of purulent fluid. Aspirated samples were evaluated by microbiology with cultures positive for methicillin-resistant Staphylococcus aureus. Trimethoprim and sulfamethoxazole were initiated for 7 days. Repeat ultrasound of the left breast demonstrated complete resolution of the left breast abscess (Fig. 3). On return visit, the patient reported decreased pain, swelling, and drainage from the left breast, and has subsequently been able to resume left breast feeding and pumping. DiscussionCellulitis, mastitis, and breast abscesses exist along a continuum, with breast abscesses occurring in 5-11 % of lactating women with infectious mastitis [1]. Most breast abscesses develop secondarily to skin contamination with S. aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Peptostreptococcus, or Bacteroides [1]. Common symptoms of breast abscesses, as illustrated by this case, include breast pain, erythema, tenderness, and increased breast temperature with or without fever or a palpable breast mass. Ultrasonography is the imaging modality of choice due to its availability, painless use, ability to conduct repeat examinations during the course of therapy, and its ability to guide percutaneous drainage [2]. In cases of confirmed breast abscesses, ultrasonography usually demonstrates a multiloculated hypoechoic fluid collection of variable shape and size with a thickened periphery and increased vascularity. According to recently published 2011 algorithm, a trial of ultrasound guided drainage is recommended for all fluid collections suggesting an abscess, regardless of size, which occur during the breastfeeding period, are caused by S. aureus, and lack a multiloculated structure. The greatest success is achieved with abscesses that are \3 cm in diameter [3,4]. Abscesses that are multiloculated or larger than 3 cm in diameter may fail ultrasound-guided drainage; thus, in such instances, early surgical evaluation for incision and drainage is strongly recommended [4]. In addition to ultrasound-guided drainage, all suspected breast abscesses should be managed with antibiotics including cloxacillin 500 mg four times daily, clindamycin 300 mg four times daily, erythromycin 500 mg three times daily, or cefazolin 500 mg four times daily for a total of 7-10 days [4,5]. B...

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“…4 Our finding was corroborative with finding in study where 33 (45%) of 73 abscesses yielded a sterile bacteriologic culture. 12 The average duration of healing in group A was 11.48 days, which was considerably low as compared to Group B which was 17.12 days. Studies including, Naeem et al reported mean healing time of 10 days in incision and drainage group and 8.6 days in needle aspiration group.…”

Section: Discussionmentioning

confidence: 79%

Surgery without knife: an ideal treatment for lactational breast abscess

et al. 2017

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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.

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Treatment of Breast Abscesses with Sonographically Guided Aspiration, Irrigation, and Instillation of Antibiotics

Abstract: Ninety-six percent of patients completing treatment were cured with this procedure. Local instillation of antibiotics is probably beneficial.

Cited by 44 publications

References 15 publications

To Compare the Results of Ultrasound Guided Aspiration and Incision and Drainage in the Management of Breast Abscess

To Compare the Results of Ultrasound Guided Aspiration and Incision and Drainage in the Management of Breast Abscess

Emergency management of puerperal breast abscess

Surgery without knife: an ideal treatment for lactational breast abscess

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