Discussion Author: Karen R Craig
A breast abscess typically presents similar to other soft tissue abscesses with progressive soreness in the breast, redness, skin thickening and increased skin temperature, and possibly fever. Most patients will have visible, palpable abnormalities that suggest abscess. The majority of patients are postpartum and nursing, but abscesses can occur at any age and without associated pregnancy or lactation.
The breast pain is typically severe and, of course, worsened by pressure of the transducer during ultrasound and breast compression during mammography.
Ultrasound is the modality of choice to evaluate patients suspected of having an abscess. Skin thickening and fluid-filled dilated lymphatics between the skin and subcutaneous tissue can be seen. The abscess collection is hypoechoic and usually not well defined. It is not always possible to predict if the abscess contents can be aspirated or if they represent a phlegmon.
Mammography is of little value and rarely performed. It may show
skin thickening, edema, and an ill-defined density or tissue asymmetry. Although the appearance of the skin is similar to what can be seen with inflammatory carcinoma, breast cancer is never as painful as breast infection. It is very rare for infection to occur in conjunction with breast cancer.
Treatment: Aspiration should be performed with an 18 gauge needle and the abscess drained as completely as possible. Large abscesses >3cm may benefit from catheter drainage. Occasionally incision and drainage and less commonly excision will need to be performed when the initial drainage is incomplete. Antibiotics are also prescribed.
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