Treatment is determined by the degree of inflamation and the stage of abscesses development.12 Patients presenting to the ED with small, early subareolar abscess should be treated conservatively with antibiotics alone for a 2-week period. Broad spectrum antibiotics should be prescribed given the high percentage of anaerobes and other aerobes other than staphylococcus aureus. Warm compresses and analgesia should be prescribed for pain relief. More severe infections may require hospitalization with intravenous antibiotics, especially in patients with systemic toxicity, diabetes mellitus, or immunocompromise. The patient treated with antibiotics as an outpatient should be referred to a surgeon for follow-up within 24 to 72 h to monitor resolution of signs and symptoms.
The appropriate surgical management of breast abscess is debated.12 If the patient presents with a fluctuant abscess, one that has drained spontaneously, or if the abscess cannot be treated by antibiotics alone, some recommend a procedure under general anesthesia with wide incision. 12 Commonly, a more conservative incision is recommended. Although some emergency physicians will perform an incision and drainage procedure in the ED, given the potential for multiloculation and the difficulty in achieving adequate analgesia required for appropriate drainage, this procedure is best performed by a breast surgeon under more ideal circumstances. Needle aspiration may be attempted. However, as noted, the abscess is usually multiloculated and the procedure is unlikely to be successful. Some recommend another conservative management approach to breast abscess with ultrasonographic assessment and aspiration.11
When evaluating a patient for breast abscess, search for a history of recurrent infection. Case series of women with subareolar abscesses have shown that recurrences occur both in patients treated with antibiotics alone and with incision and drainage in addition to antibiotics. 12 Recurrent infections may best treated by incision of the ducts, at the discretion of the breast surgeon.
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