Breast Abscess

• Delayed and existing mastitis; about three percent of patients with mastitis develop an abscess. Berens, PD. (2019). Breast Pathology. In: Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning. 
• Inadequate or inappropriate antibiotic treatment of mastitis.
• Unresolved breast infection.

• Antibiotics are required.
  • Over 50% can be MRSA.
  • Any abscess drainage should be cultured.
• Initial management of lactational breast abscess is ultrasound guided aspiration in most situations. Very large abscesses or situations in which the patient is systemically ill or immune suppressed may require hospitalization. Abscesses > 10 cm may benefit from surgical incision and drainage.  
• More than one aspiration at frequent intervals (2-4 days) may be required while using antibiotics if the abscess has reaccumulated.
• Drainage catheter may be needed with larger abscesses (6+ cm).
• With a larger abscess > 10cm or when the abscess persists despite recurrent aspirations, consider surgical incision and drainage (picture above).
• Rest and adequate hydration are recommended.
• Breastfeeding may continue.
• Keeping the breast empty is essential.

Clinical Guidelines

• Amir, L.H.; Academy of Breastfeeding Medicine Protocol Committee  (2014). ABM clinical protocol #4: Mastitis, revised March 2014. Breastfeeding Medicine, 9(5), 239–243. 
• Mitchell, K.B., Johnson, H.M., Eglash, A., & Academy of Breastfeeding Medicine (2019). ABM Clinical Protocol #30: Breast Masses, Breast Complaints, and Diagnostic Breast Imaging in the Lactating Woman. Breastfeeding Medicine, 14(4), 208-214. 

References

1. Amir, L.H., Trupin, S., & Kvist, L.J. (2014) Diagnosis and treatment of mastitis in breastfeeding women. Journal of Human Lactation, 30 (1), 10–13. 
2. Boccaccio, C., Verdaguer Babic, V., Botto, L., Cervetto, M.M., Cetani, S., Paladino, S., Conti, R., Lanzillota, A., Herrera, R., & Amarante, D. (2014). Aislamiento de Staphylococcus aureus meticilino resistente en abscesos de mama en una Maternidad Pública [Methicillin-resistant Staphylococcus aureus (MRSA) isolation in breast abscesses in a Public Maternity]. Medicina, 74(3), 210-215
3. Campbell, S.H., Lauwers, J., Mannel, R., & Spencer, B. (2019) Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning. 
4. Chen, C., Luo, L.B., Gao, D., Qu, R., Guo, Y. M., Huo, J. L., & Su, Y. Y. (2019). Surgical drainage of lactational breast abscess with ultrasound‐guided Encor vacuum‐assisted breast biopsy system. The Breast Journal, 25(5), 889–897.
5. Colin, C., Delov, A.G., Peyron-Faure, N., Rabilloud, M., & Charlot, M. (2019). Breast abscesses in lactating women: evidences for ultrasound-guided percutaneous drainage to avoid surgery. Emergency Radiology, 26(5), 507-514. 
6. Irusen, H., Rohwer, A.C., Steyn, D.W., & Young, T. (2015). Treatments for breast abscesses in breastfeeding women. The Cochrane Database of Systematic Reviews, (8), CD010490.
7. Kang, Y.D., & Kim, Y.M. (2016). Comparison of needle aspiration and vacuum-assisted biopsy in the ultrasound-guided drainage of lactational breast abscesses. Ultrasonography (Seoul, Korea), 35(2), 148–152. 
8. Lawrence, R.A., & Lawrence, R.M. (2016). Breastfeeding: a guide for the medical profession (8th ed.). Elsevier.
9. Marín, M., Arroyo, R., Espinosa-Martos, I., Fernández, L., & Rodríguez, J.M. (2017) Identification of Emerging Human Mastitis Pathogens by MALDI-TOF and Assessment of Their Antibiotic Resistance Patterns. Front in Microbiology, 81258.