Management of Breast Abscess during Breastfeeding

Paola Pileri, Alessandra Sartani, Martina Ilaria Mazzocco, Sofia Giani, Sara Rimoldi, Gaia Pietropaolo, Anna Pertusati, Adriana Vella, Luca Bazzi and Irene Cetin
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Paola Pileri: Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, Via L. Castelvetro 32, 20154 Milan, Italy
Alessandra Sartani: Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy
Martina Ilaria Mazzocco: Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, Via L. Castelvetro 32, 20154 Milan, Italy
Sofia Giani: Departmental Breast Unit, ASST Fatebenefratelli Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy
Sara Rimoldi: Laboratory of Clinical Microbiology, Virology and Diagnostics of Bioemergencies, ASST Fatebenefratelli Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy
Gaia Pietropaolo: Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy
Anna Pertusati: Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy
Adriana Vella: Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy
Luca Bazzi: Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy
Irene Cetin: Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, Via L. Castelvetro 32, 20154 Milan, Italy

IJERPH, 2022, vol. 19, issue 9, 1-9

Abstract: (1) Background: Breast abscess (BA) is a condition leading in the majority of cases to breastfeeding interruption. Abscesses are commonly treated with antibiotics, needle aspiration or incision and drainage (I&D), but there is still no consensus on the optimal treatment. Since there are no well-defined clinical guidelines for abscess management, we conducted a retrospective, observational study with the aim of assessing ultrasound (US)-guided management of BA without surgery, regardless of the BA size. The secondary objective was the microbiologic characterization and, in particular, the S. aureus methicillin resistance identification. (2) Methods: our population included 64 breastfeeding mothers with diagnosis of BA. For every patient, data about maternal, perinatal and breastfeeding features were collected. All patients underwent office US scans and 40 out of 64 required a more detailed breast diagnostic ultrasound performed by a radiologist. In all cases, samples of milk or abscess material were microbiologically tested. All patients received oral antibiotic treatment. We performed needle aspiration, when feasible, even on abscesses greater than 5 cm. (3) Results: most of the women developed BA during the first 100 days (68.8% during the first 60 days) after delivery and 13 needed hospitalization. Four abscesses were bilateral and 16 had a US major diameter greater than 5 cm. All patients were treated with antibiotic therapy according to our clinical protocol and 71.9% (46/64) underwent fine needle aspiration. None of them required I&D. The average duration of breastfeeding was 5 months (IR 2; 9.5) and 40.6% of women with BA continued to breastfeed for more than 6 months. Only 21 mothers interrupted breastfeeding before 3 months. (4) Conclusions: our observational data suggest, regardless of the size and the clinical features of the BA, a conservative approach with antibiotic therapy targeted at the Methicillin-Resistant Staphilococcus aureus (MRSA) identified and needle aspiration, if feasible. In our experience, treatment with needle aspiration is a cost- effective method. Unlike drainage, it is an outpatient procedure, easily repeatable, with no cosmetic damage. In addition, it has lower risk of recurrences since, differently from surgical incision, it does not cause interruption of the ducts. Moreover, needle aspiration is less painful, does not require the separation of the mother-child dyad and allows for a quicker, if not immediate, return to breastfeeding.

Keywords: breast abscess; breastfeeding; needle aspiration; surgery (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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