Management of breast abscess

1. MANAGEMENT OF BREAST
ABSCESS
PRAVEER MANDAL, INTERN
MODERATOR: Dr. SANJAY YADAV
DEPARTMENT OF GENERAL SURGERY

2. OBJECTIVES
 To know about relevant anatomy of breast
 To know what is breast abscess, its risk
factors and its type,
 To know how to investigate the case of
breast abscess
 To know how to treat a case of breast abscess

3. CONTENT
1. Relevant anatomy of breast
2. Risk factors and causative organism
3. Types of breast abscess
4. Clinical features
5. Investigations
6. Treatment

4. ANATOMY OF BREAST

5. BREAST ABSCESS
• It is the pus filled cavity in the breast lined by
epithelium.
• Usually Complication of infectious mastitis

6. RISK FACTORS
1. Lactating mother
2. Primigravida
3. Cracked nipple
4. Obesity
5. Smoking
6. Diabetes mellitus
7. Trauma
8. Steroid therapy

7. CAUSATIVE ORGANISMS
1. Staphylococcus aureus
2. Staphylococcus epidermidis
3. Streptococcal pyogenes
4. Bacteriodes
5. Peptostreptococcus
6. Mycobacterium tuberculosis
7. Candida albicans

8. TYPES OF BREAST ABSCESS
1. Lactational breast abscess
2. Non lactational breast abscess
a) Central
b) Peripheral

9. CLINICAL FEATURES
SYMPTOMS
• Pain at affected breast
• Fever with chills and rigor
• Palpable lump
SIGN
• Cystic tender erythematous
lump in the breast with or
without fluctuation.
• Nipple retraction

10. INVESTIGATIONS
1. ULTRASOUND BREAST
• Well circumscribed hypo echoic lesion mostly
multiloculated without vascularity within
collection with acoustic enhancement

11. INVESTIGATIONS
2. DIAGNOSTIC NEEDLE ASPIRATION
• Purulent aspirate proves the diagnosis
• Can be diagnostic and therapeutic
• Pus is sent for culture and sensitivity

12. TREATMENT
1. INCISION AND DRAINAGE
2. NEEDLE ASPIRATION
3. VACCUM SUCTION DRAINAGE

13. SUPPORTIVE MANAGEMENT
1. Warm compression
2. Encouraging breast feeding or manual breast
evacuation
3. Breast support
4. Antibiotics – flucloxacillin, metronidazole or
amoxicillin + clavulanic acid.

14. INCISION AND DRAINAGE
• INDICATION
1. Failure to resolve within 48 hours of
antibiotic therapy
2. Area of tense induration even after emptying
of milk
3. Evidence of underlying abscess

15. STEPS OF INCISION AND DRAINAGE
1. Well informed understood written consent is
obtained
2. Anesthesia- local or general
3. Incision- Radial incision over affected
segment
4. Incision deepened into subcutaneous tissue

17. STEPS OF INCISION AND DRAINAGE
5. Artery /sinus forceps thrushed into abscess
cavity
6. Every part of abscess is palpated against the
point of artery forceps and its jaws are opened
7. Artery forceps withdrawn and finger
introduced and remaining septa disrupted
8. Wound is lightly packed with ribbon gauze or
drain to allow drainage

18. USG GUIDED NEEDLE ASPIRATION

19. VACCUM SUCTION DRAINAGE

21. INCISION AND DRINAGE VS NEEDLE
ASPIRATION

22. NEEDLE ASPIRATION VS SUCTION
DRAINAGE

23. COMPLICATIONS OF BREAST ABSCESS
1. Antibioma formation
2. Milk fistula formation
3. Recurrence
4. Septicemia

24. TAKE HOME MESSAGE
1. Breast abscess is pus filled cavity in breast
which can be puerperal or non puerperal
2. Repeated USG guided needle aspiration
under antibiotic cover is recommended
3. Incision and drainage of breast abscess is
mostly performed
4. Vaccum suction drainage is next modality of
treatment.

25. REFERENCES
1. BAILEY AND LOVE’S SHORT PRACTICE OF
SURGERY 27TH EDITION
2. Breast abscesses: evidence-based algorithms
for diagnosis, management, and follow-up
Isabelle Trop 1, Alexandre Dugas, Julie
David, Mona El Khoury, Jean-François
Boileau, Nicole Larouche, Lucie Lalonde

26. THANK YOU