A breast abscess is a localized collection of pus within the breast tissue, often forming as a complication of mastitis (inflammation of the breast). While most frequent in lactating women, it can also affect non-lactating individuals. The abscess is a painful, tender lump, often appearing with overlying skin redness, warmth, and swelling. Because an abscess indicates infection progression, it requires prompt medical diagnosis and intervention to prevent complications and ensure proper healing.
Primary Medical Treatment Options
The core treatment involves two parallel strategies: removing the accumulated pus and eliminating the underlying bacterial infection. Drainage is accomplished through one of two primary procedures, chosen based on the abscess size and complexity.
Needle aspiration, often guided by ultrasound imaging, is the preferred initial method. It is less invasive and can often be performed in an outpatient setting with local anesthesia. This procedure involves inserting a fine needle or cannula to withdraw the fluid. Aspiration may need to be repeated over several days to achieve complete drainage, particularly for larger collections. Ultrasound guidance is instrumental in confirming evacuation and monitoring resolution.
For larger abscesses, those with multiple internal compartments (multiloculated), or those that fail to resolve after aspirations, Incision and Drainage (I&D) is necessary. I&D involves making a small cut in the skin to allow the pus to drain fully. The wound is often left open and packed with gauze, which results in a longer healing time and higher risk of scarring compared to aspiration.
Antibiotic treatment is mandatory regardless of the drainage method. Treatment targets bacteria, most commonly Staphylococcus aureus or Streptococcus species. Treatment is often started empirically with a broad-spectrum antibiotic, and the drained fluid is cultured to identify the specific bacteria and adjust the medication if necessary.
Supportive Care and Healing Process
Effective recovery depends on post-procedure care and symptom management at home. Pain relief is managed using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to reduce both pain and inflammation. Patients must complete the full course of prescribed antibiotics, even if symptoms rapidly improve, to ensure the infection is eradicated and prevent recurrence.
Applying a warm compress or heat to the affected breast provides comfort and improves local circulation, aiding healing. If surgical I&D was performed, careful wound care is necessary, including following instructions for changing dressings and managing any temporary drainage tubes. Keeping the wound site clean and dry prevents secondary infection.
Patients should monitor for signs of worsening infection, such as persistent or high fever, rapidly spreading redness, or increased pain in the treated area. Follow-up appointments are routinely scheduled to assess the resolution of the abscess, often including a repeat ultrasound scan to confirm that no fluid collection remains.
Special Considerations for Lactating Patients
Treatment plans for lactating women prioritize maternal health and the continuation of breastfeeding. Patients are strongly encouraged to continue emptying the affected breast through nursing or pumping, unless specifically advised otherwise. Maintaining milk flow helps relieve milk stasis, a contributing factor to infection, and promotes faster healing.
Continued breastfeeding is generally safe for the infant, as the bacteria causing the abscess are typically common skin organisms. The benefits of continued lactation often outweigh the minimal risk of transmission. Antibiotic selection is tailored to ensure the medication is safe for the nursing infant, with options like amoxicillin/clavulanate or cephalosporins commonly used.
Temporary discomfort during nursing may occur, but emptying the breast remains the primary goal. If a mother is advised to temporarily stop nursing on the affected side, she should continue to pump to maintain milk supply and prevent further engorgement. Lactation support professionals can offer guidance on proper latch and techniques to reduce pain and prevent future episodes of mastitis.