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You are caring for a 19 year old woman who is breastfeeding her 2 month old infant. She has a superficial 2cm breast abscess located on her inferior breast with minimal overlying cellulitis and no involvement of the nipple. She is nontoxic, afebrile, and not septic appearing. Which of the following ED management choices is most appropriate and most likely to result in rapid improvement?
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January 27, 2021 at 6:14 pm
D) Needle aspiration
Breast abscesses can be characterized as lactation related or non-lactation related. For lactation-related, continued milk drainage is helpful for resolution, so stopping breastfeeding would be inappropriate. However, milk drainage alone is insufficient for rapid improvement without a procedure to remove the purulent fluid collection. Of the two procedures listed, the most appropriate for ED management is needle aspiration. While an ED physician could perform incision and drainage, there are concerns about disruption of breast architecture for deeper abscesses, and referral to the surgeon as an outpatient is not the best choice to result in rapid improvement.