Editing Breast abscess (section)

== '''Management''' ==

* Approach
** Antibiotics and frequent emptying of the breast (step up approach)
* Simple advice:
** Continued milk draining is important - essentially drains the abscess, resulting in reduced duration of symptoms and improved outcome
** Not a contraindication to breastfeeding on that side
** Warm soaks are helpful for mastitis
* Antibiotics
** Flucloxacillin 
** Consider anaerobic organisms if subareolar location, hidradenitis suppuritiva, recurrent abscess - Augmentin DF would be a good option for a non-lactational infection
** MRSA is possible but uncommon
* Percutaneous drainage
** Appropriate first-line when skin is viable
** Repeat every 2-3 days until no collection remains or the fluid aspirated is serous
** Few abscesses require more than 2-3 drainages
** Pigtail catheters can be placed if desired, but not normally necessary
** Technique
*** Can be USS-guided if desired
*** First try with a 21 gauge needle and inject LA + adrenaline
*** If pus is too thick, use a 19 or 17 gauge needle
*** Wash out cavity until clear
*** Irrigate with LA solution
** Risk factors for failure of aspiration:
*** Abscess >5cm in diameter
*** Unusually large volume of aspirated pus
*** Delay to treatment
* Surgical drainage
** Indications
*** Compromised overlying skin (ischaemia/pressure necrosis) - see bottom for examples of compromise
*** Skin overlying abscess is very thin and shiny, or if it appears like the abscess is about to burst through the skin
*** Not responsive to percutaneous aspiration
*** Repeated infections requiring excision of subareolar duct complex, and sometimes the entire NAC
** Technique
*** See separate topic
* Follow-up
** MMG and USS six weeks post-presentation for all women to exclude IBC