Lactational Breast Abscesses

• Lactational breast abscesses:
  • Develop in up to a quarter of all breastfeeding women:
    • Typically within the first 12 weeks after birth or during the weaning process
• Breast abscesses:
  • Rarely resolve with antibiotics alone
• Abscesses generally require:
  • Drainage in conjunction with antibiotics
• Depending on the prevalence of community-acquired MRSA in the region in which the patient presents:
  • MRSA coverage may be empirically initiated
• A recent Cochrane review:
  • Found insufficient evidence to determine whether:
    • Needle aspiration is a more effective option to incision and drainage (I&D) for lactational breast abscesses, or whether an antibiotic should be routinely added to women undergoing I&D for lactational breast abscesses
    • The evidence for the primary outcome of treatment failure is low quality, with downgrading based on including small studies with few events and unclear risk of bias
• The American Society of Breast Surgeons:
  • Has recommended an attempt at needle aspiration as first-line treatment for a breast abscess
• Compared to operative incision and drainage:
  • Fine needle aspiration offers decreased morbidity
• References:
  • Rao R, Ludwig K, Bailey L, Berry TS, Buras R, Degnim A, 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;25(1):2795-2800.
  • Boakes E, Woods A, Johnson N, Kadoglou N. Breast infection: a review of diagnosis and management practices. Eur J Breast Health. 2018;14(3):136-143.
  • Irusen H, Rohwer AC, Steyn DW, Young T. Treatments for breast abscesses in breastfeeding women. Cochrane Database Syst Rev. 2015(8):CD010490.

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