Ultrasound guided needle aspiration bests incision and drainage for breast abscess: Study

Breast abscess is defined as an acute inflammatory lump which yields pus on incision/aspiration. The frequency of occurrence is highly related to pregnancy and caused due to nipple piercing by a child during feeding and bacterial colonization due to improper nursing technique and incomplete emptying of the breast. Non-lactational breast abscesses are entirely different from those occurring during breastfeeding. They occur in the peri-areolar tissues, frequently recur, and infecting organisms are a mixture of anaerobes.

Once an abscess is established, management involves incision and drainage by providing general anesthesia however this is associated with regular dressing, prolonged healing time, difficulty in breastfeeding, possible unsatisfactory cosmetic outcome, rupture, and recurrent breast abscess. Hence nowadays treatment of breast abscess by repeated needle aspiration with or without ultrasound guidance gained importance. This procedure has been used successfully and is associated with less recurrence, excellent cosmetic result, and has less cost.

Therefore, Rajiv Karvande and his team from the Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India, carried out this study to effectively compare the outcome and effectiveness of traditional treatment incision and drainage against needle aspiration in the treatment of breast abscess.

This comparative study was conducted in the department of general surgery in a tertiary health care center, for a period of 2 years where a total of 60 female patients of age between 18-65 years diagnosed with breast abscess with the abscess size of less than 10 cm in diameter on ultrasonography were assessed. Out of the total sample, 30 had undergone aspiration of the breast abscess (group A) and 30 had undergone incision and drainage of the breast abscess (group B).

The authors noted that of the total number of patients, 90% of the cases were lactating. The results highlighted were-

7. S. aureus was the common organism isolated in both lactating and non-lactating cases, encountered in 34 patients (57.7%). Out of that, 20 were in the aspirated group (66.7%). 14 patients were in the incised group (46.7%).
8. The mean healing time and the cosmetic outcome was significantly (p = 0.001) very good in patients treated with needle aspiration compared to incision and drainage.
9. There was no recurrence of breast abscess observed in the needle aspiration group during the study.
10. There was a 3.3% recurrence rate observed in the incision and drainage group.

Hence, "aspiration of the breast abscess through a wide bore cannula is thus a feasible and easy procedure but may require multiple aspirations for a cure. It does not require any mode of anesthesia and can be done on out-patient department basis. Breast abscess in a selected group of patients with a diameter of less than 7 cm can be treated by aspiration successfully and with a good cosmetic outcome", the authors concluded.

"Aspiration of the breast abscess can be successfully done as an initial mode of management in the treatment, but incision and drainage remain the final resort for the cure", they further added.