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Breast abscesses in lactating women: evidences for ultrasound-guided percutaneous drainage to avoid surgery

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Abstract

Background

Surgical incision with drainage remains the first-line therapy recommendation for breast abscesses greater than 5 cm.

Purpose

To determine recovery with ultrasound guided (US-guided) procedures for treatment of lactational breast abscesses without surgical incision for drainage.

Material and methods

Institutional review board approval and written informed patient consent were obtained for this retrospective study. From May 1, 2009, to June 1, 2018, 92 consecutive women (mean age 30 years, range 18–45) with 105 abscesses were treated with oral antibiotics and US-guided percutaneous drainage under local anesthesia. A total number of 202 US-guided procedures were performed. Three techniques were used: needle aspiration (diameter 18 to 14G), pigtail catheter insertion (diameter 5 to 7F), and/or vacuum-assisted biopsy/aspiration (diameter 10G). When using needle aspiration or pigtail catheter, a saline irrigation of the cavity was performed according to pus viscosity.

Results

The median diameter of abscesses was 4.5 cm (range 1–15), 82/105 (78%) were larger than 3 cm and 40/105 (38%) larger than 5 cm. US-guided management was successful for 101/105 (96%; 95% CI, (91–99%)) abscesses regardless the size. After the first round of procedures, 49/105 (47%) abscesses were recovered, 56/105 (53%) needed more than one drainage with a median number drainages of 2.6 (2–6). In 4/105 cases (4%), women underwent additional surgery under general anesthesia. By excluding abscesses which occurred in the weaning phase (n = 17), breastfeeding carried on for 68/75 (91%) women.

Conclusion

Unlike previous studies, US percutaneous guided management of lactational abscesses is effective even for abscesses greater than 5 cm and allows continued breastfeeding.

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Abbreviations

BA:

Breast abscess

US:

Ultrasound

NA:

Needle aspiration

PC:

Pigtail catheter

SI:

Saline irrigation

VAB:

Vacuum-assisted biopsy

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Authors and Affiliations

  1. Department of Radiology, Breast Imaging, Hospices Civils de Lyon, Centre Hospitalier Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France

    Catherine Colin & Ana Gjorgjievska Delov

  2. Department of Radiology, Women Imaging, Private clinic Val d’Ouest, Charcot, 53 rue commandant Charcot, 69110, Sainte Foy-lès-Lyon, France

    Noémie Peyron-Faure

  3. Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, 69000, Lyon, France

    Muriel Rabilloud

  4. Université Lyon1, 69100, Villeurbanne, France

    Muriel Rabilloud

  5. CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, 69100, Villeurbanne, France

    Muriel Rabilloud

  6. Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France

    Mathilde Charlot

Authors
  1. Catherine Colin
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  2. Ana Gjorgjievska Delov
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Corresponding author

Correspondence to Catherine Colin.

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The institutional review board Ethical Committee approved this study and the requirement of informed patient consent was obtained.

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The authors declare that they have no conflict of interest.

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Colin, C., Delov, A.G., Peyron-Faure, N. et al. Breast abscesses in lactating women: evidences for ultrasound-guided percutaneous drainage to avoid surgery. Emerg Radiol 26, 507–514 (2019). https://doi.org/10.1007/s10140-019-01694-z

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  • DOI: https://doi.org/10.1007/s10140-019-01694-z

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