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Breast abscesses in breastfeeding women

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Some women develop a breast abscess while breastfeeding, called a lactational breast abscess. An abscess is a collection of infected fluid within the breast tissue. The aim of treatment is to cure the abscess quickly and effectively, ensuring maximum benefit to the mother with minimal interruption of breastfeeding.

Presently, lactational breast abscesses are treated by incision and drainage or needle aspiration, with or without diagnostic ultrasound. Antibiotics may or may not be prescribed. For incision and drainage the abscess is cut open with a scalpel (blade) to release the infected fluid. In these patients we prefer to plan a low visibility incision, usually at the border of the areola, to reduce the cosmetic impact of the scar on these young women. In most cases, the abscess can be effectively drained and local cures performed normally. We present two clinical cases with a favorable evolution after drainage

26-year-old woman with abscess during breast feeding in the left breast. An incision was planned on the areolar border for the abscess duct
During the closure gauzes were placed in the cavity. and two sutures were also made at both ends of the wound to improve final healing
Final cosmetic result

A less invasive way to treat the breast abscess is by needle aspiration. A needle is inserted into the cavity of the breast abscess and a syringe is used to draw out the infected fluid, often using ultrasound guidance. As there are advantages in using this method e.g. no scars, reduced hospitalisation etc. the trend is to use this method more often.

You can consult Cochrane Review in this link. The authors concluded that rhere is insufficient evidence to determine whether needle aspiration is a more effective option to I&D for lactational breast abscesses, or whether an antibiotic should be routinely added to women undergoing I&D for lactational breast abscesses. We graded the evidence for the primary outcome of treatment failure as low quality, with downgrading based on including small studies with few events and unclear risk of bias.

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