Ultrasound Guided Aspiration of Breast Abscesses in Lactating Women – a Case Report

Breast abscesses can result as a complication of delayed or inadequate treatment of lactation-related mastitis. The reported incidence is 5 to 11%. They were traditionally treated by surgical incision and drainage. This strategy often required general anasthesia and a hospital stay. Most of the patients stopped breastfeeding. In the past years non-operative outpatient treatment by needle aspiration under ultrasound guidance has become increasingly popular. In the majority of cases there is no negative effect on breastfeeding.

CASE: A healthy 30 year old breastfeeding primipara delivered by cesarian section three weeks before was referred to our unit with clinical suspicion of a breast abscess in the upper-inner quadrant of the right breast. She presented a palpable fluctuant tumor in the setting of mastitis. The ultrasound examination revealed a 5.6 cm wide hypoechoic lesion with enhancement confirming an abscess. We performed an ultrasound guided needle aspiration under local anasthesia and started cephalosporine orally. 60ml pus was aspirated. The culture showed Staphylococcus aureus as the responsable microorganisme. In the follow-up we reaspirated the abscess cavity another two times until the abscess was no longer visible in ultrasound. Breast-feeding was never interrupted. After three months the patient came to the last follow-up showing a good lactation and cosmetic result.

This case report shows that ultrasound guided aspiration combined with antibiotics has a great value in the treatment of breast abscesses even in lesions with a large volume. Altough repeated aspirations are needed to obtaine complete resolution this therapy is a well accepted alternative to surgical treatment.

breast abscess - needle aspiration - breastfeeding