Catherine Streeto Giess MD, Presenter: Nothing to Disclose

Mehra Golshan MD, Abstract Co-Author: Nothing to Disclose

Karen Flaherty RN, Abstract Co-Author: Nothing to Disclose

Robyn L. Birdwell MD, Abstract Co-Author: Nothing to Disclose

The purpose of this study was to 1) assess success rate of needle aspiration in the treatment of large and small breast abscesses; 2) evaluate factors associated with treatment by aspiration alone, versus aspiration with surgical incision and drainage (I/D); 3) develop a multidisciplinary management algorithm.    

Retrospective review of the breast ultrasound database from 1/1/2008 -12/31/10 identified 41 patients with breast abscesses who underwent aspiration, with or without surgical incision and drainage (I/D).  All patients received antibiotics. Only cases with positive microbiology and/or pathology reported as consistent with abscess were included.   Demographics, the longitudinal medical record, imaging, abscess size, number of aspirations, and microbiology were abstracted for this analysis.

Twenty-two patients underwent aspiration only, 16 > 3cm and 6 < 3 cm diameter (mean 4.3 cm, range 0.9-10 cm).  Known risk factors included 12 lactational and 4 with recent biopsy.  Fourteen had one intervention (13 aspiration, 1 core biopsy), 6 had two interventions (5 had two aspirations; 1 had aspiration, with later catheter  placement), and 2 had 3 aspirations.  Ultrasound appearance ranged from mostly cystic to more solid.  Complex/solid appearance delayed aspiration in 3 patients.  Positive cultures in 19 showed staphylcoccus (11 aureus, 4 coagulase negative, 4 MRSA); 3 had pathology reported as consistent with abscess. Nineteen patients underwent aspiration and I/D, 15 > 3 cm, 4 < 3 cm diameter (mean 4.2 cm, range 2.2-7.5 cm).  Known risk factors included 4 lactational, 3 recurrent subareolar abscess, 1 smoking, 4 diabetes mellitus, 1 hydradenitis suppurativa, 1 nipple piercing, 1 lumpectomy.  Sixteen had 1 aspiration, and 3 had 2 aspirations.  Known reasons for I/D included lack of improvement/recurrence in 10, fistula in 3, and electively after resolution in 3.  Positive cultures included 5 staphylococcus (3 MRSA), and 14 other organisms, many anaerobic.

Acute and lactational abscesses are effectively managed with aspiration, even when large or sonographically complex.  Recurrence, anaerobic culture, chronicity, or complications such as skin breakdown or fistula formation may require surgical intervention for resolution.

Aspiration is an effective treatment for breast abscesses, even when large or complex; surgery may be reserved for chronic or recurrent infections, or complications such as fistula.

Giess, C, Golshan, M, Flaherty, K, Birdwell, R, Clinical Experience with Aspiration of Large and Small Breast Abscesses at an Academic Medical Center: Implications for a Multidisciplinary Management Algorithm.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11002056.html