Management of Common Complications of Lactation – Drainage of Abscess and Galactocele

• Myth:
  • Fluid collections in the lactating breast require operative incision and drainage or aspiration alone
• Science:
  • As surgeons have moved away from large incision and drainage procedures performed on the lactating breast in the operating room setting:
    • They have turned to minimally invasive aspiration approach:
      • However, aspiration alone can result in incomplete drainage
  • Unlike simple breast cysts, abscesses and galactoceles in the lactating breast contain breastmilk:
    • Which is highly viscous and loculated (Figure):
      • Therefore, a needle aspiration alone will likely remove only part of the fluid collection, particularly if it is chronic
      • If a needle aspiration is successful in removing the entire volume of an acute collection:
        • The area can refill with milk very quickly and require repeated procedures
• Treatment:
  • Lactational abscess and infected galactocele:
    • Require drainage for source control
  • Drainage may also be appropriate for symptomatic noninfected galactoceles:
    • Small stab incision and drain placement will definitively resolve fluid collections in the lactating breast:
      • The small stab incision allows for access to the cavity with an instrument that can be used to disrupt loculations and provide complete drainage, such as a hemostat
      • A stent or drain can be placed to allow passive decompression of the area for 3 to 5 days:
        • This could involve a Penrose drain, Seromacath, Blake drain, or other wicks such as a small foley catheter:
          • Drains should be placed to gravity rather than suction
  • In addition to the surgical management, many patients developing fluid collections during lactation require treatment of idiopathic or iatrogenic hyperlactation:
    • Patients should not be instructed to massage their breast:
      • As this results in tissue necrosis and phlegmon development
    • Ice and antiinflammatory medication by mouth should be recommended for symptomatic relief
    • Antibiotics may be indicated if significant surrounding cellulitis exists

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