Lam E, Chan T, Wiseman SM. Breast abscess: evidence based management recommendations. Expert Rev Anti Infect Ther. 2014 Jul;12(7):753-62.

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Key issues:

• All breast abscesses should be treated with abscess drainage and concurrent empiric antibiotic therapy.
• Needle aspiration either with or without ultrasound guidance should be employed as first-line treatment of breast abscesses. However, multiple aspiration sessions may be required.
• Ultrasound-guided percutaneous catheter placement may be considered as an alternative approach for drainage of larger (>3 cm) abscesses.
• Surgical incision and drainage is required if needle aspiration or catheter drainage is unsuccessful and there is progression of infection.
• Surgical incision and drainage should be considered for first-line therapy of large (>5 cm), multiloculated or long-standing breast abscesses.
• Cultures should be obtained at the time of abscess drainage and antibiotic management tailored to the infecting organism’s susceptibility profile.
• Empiric antibiotics targeting methicillin-resistant S. aureus may be required for patients who are known to be colonized or considered to be at high risk.
• For breastfeeding women, the infant should not nurse from the breast with the abscess but may continue nursing from the contralateral, uninfected breast.
• Future research should prospectively evaluate the utilization of aspiration or percutaneous catheter drainage techniques in terms of frequency of progression of infection requiring surgical management in order to limit selection biases. The optimal frequency of aspirations, time interval between aspirations and duration of catheter placement also requires further study.

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