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ABASTRACT

OBJECTIVE

We studied the feasibility of treating breast abscesses with sonographically guided aspiration, irrigation, and local instillation of antibiotics without placing indwelling catheters.

MATERIALS AND METHODS

Seventy-three patients with breast abscesses were seen from 1995 to 2001. Aspiration and irrigation were performed under sonographic guidance. Repeated aspiration was performed when deemed necessary. One gram of cephradine was injected into 29 abscesses measuring more than 25 mm.

RESULTS

Six patients refused further treatment after failure of the first aspiration and elected surgical drainage. Of the remaining 67 patients who completed treatment, 38 required one aspiration for cure, 18 required two aspirations, and eight required more than two aspirations. The treatment failed and surgical drainage was required in only three of the 67 patients completing treatment.

CONCLUSION

Ninety-six percent of patients completing treatment were cured with this procedure. Local instillation of antibiotics is probably beneficial.

Introduction

Acute bacterial mastitis either resolves under antibiotic therapy or evolves toward a pyogenic abscess. Rarely, breast abscesses present with no history of acute mastitis. Traditional treatment of breast abscesses is by surgical incision, digital disruption of septa, evacuation of contents with occasional placement of surgical drains, and administration of systemic antibiotics. This strategy often requires general anesthesia, may leave unpleasant scars, is more expensive than aspiration, requires regular postoperative changes of dressing, and interferes with lactation. In addition, 10–38% of abscesses recur and need additional surgical drainage [1].

Imaging-guided (with sonography or CT) percutaneous treatment of purulent collections and placement of indwelling catheters in nonbreast sites have become increasingly popular since the 1980s. A more conservative approach for breast abscesses using percutaneous needle aspiration, irrigation of the cavity, instillation of local antibiotics, and systemic antibiotics, has also been facilitated with the introduction of high-resolution real-time sonography. It has been reported in the literature that abscesses larger than a mean of 21.5 mL [2] or 3 cm in diameter [3] treated by aspiration and irrigation without instillation of local antibiotics have a lower success rate than smaller abscesses. The purpose of this study is to review our experience in the treatment of breast abscesses using aspiration, irrigation, and instillation of antibiotics.

Materials and Methods

Our patient population consisted of 73 women with 73 breast abscesses who were seen during 1995–2001. The median age was 37 years (range, 16–75 years). Only 14% of the abscesses were in a lactating breast. Sixty-three percent occurred in the central retroareolar breast; the remaining abscesses were located in the periphery of the breast. Only 12% were associated with fever. All patients had a palpable mass; in 80% the mass was painful, and in 71% the overlying skin was red.

Real-time sonography (Fig. 1A1B) was performed by a radiologist with a 7-13–MHz linear array transducer (Dynaview II, SSD-1700, Aloka, Tokyo, Japan). Patients with acute mastitis in whom a collection was not seen on sonography were excluded. The median long-axis diameter was 34 mm (range, 15–80 mm) as measured by the calipers on the sonogram.

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