Abscesses of the breast - US-guided serial percutaneous aspiration and local antibiotic therapy after unsuccessful systemic antibiotic therapy

Purpose: The usual therapeutic approach to acute breast abscesses (ABAs) not responsive to systemic antibiotics is surgical incision and drainage. Our purpose was to assess the efficacy of treating ABAs with serial US-guided percutaneous aspiration and local injection of antibiotics. Material and Methods: Twenty-six patients with 28 ABAs, in whom systemic antibiotic therapy had failed, underwent serial US-guided aspiration with local injection a of large-spectrum antibiotic. The treatment was repeated weekly until complete resolution was observed at clinical and US examination. The volume of the ABAs was calculated before each US-guided aspiration. Followup US examinations were performed at 1, 4, and 12 weeks after clinical and US resolution. A comparison betweeen costs of surgical and US-guided treatment of ABAs in our institution was done. Results: In 27 ABAs the treatment was successful: a progressive volume reduction and a complete resolution at clinical and US examination was observed within 1 to 7 weeks. In 1 case only, with a large ABA markedly increased in volume at the second examination, surgical drainage was performed. Conclusion: US-guided aspiration with local antibiotic injection is a safe and effective approach to ABAs, cheaper than surgical drainage of these lesions.