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Old 05-29-2012
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Question Breast abscess: Antibiotics or Needle Aspiration or I&D

A 19-year-old mother of a healthy 5-week-old infant visits her gynecologist complaining of pain during breastfeeding. The pain began 2 days ago. On examination, in the right breast, there is a fluctuant mass palpated in the periareolar area that is extremely tender, warm, and erythematous. Which of the following is the indicated initial treatment for this patient?

A. Needle aspiration only
B. Nonsteroidal anti-inflammatory drugs (NSAIDs) and warm compresses only
C. Oral cephalexin and surgical incision and drainage
D. Oral erythromycin only
E. Surgical incision and drainage only
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Quote:
Originally Posted by tyagee View Post
A 19-year-old mother of a healthy 5-week-old infant visits her gynecologist complaining of pain during breastfeeding. The pain began 2 days ago. On examination, in the right breast, there is a fluctuant mass palpated in the periareolar area that is extremely tender, warm, and erythematous. Which of the following is the indicated initial treatment for this patient?

A. Needle aspiration only
B. Nonsteroidal anti-inflammatory drugs (NSAIDs) and warm compresses only
C. Oral cephalexin and surgical incision and drainage
D. Oral erythromycin only
E. Surgical incision and drainage only
but not sure, atypical case
usually mastitis associated with breast feeding isn't associated with fluctuant mass and is treated with warm compression and NSAIDs
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C. surgical incision and drainage + antibiotic

all abcess need to be drained. rule of thumb. with appropriate antibiotic coverage!

its my guess
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Originally Posted by shyangel18 View Post
C. surgical incision and drainage + antibiotic
all abcess need to be drained
. rule of thumb. with appropriate antibiotic coverage!
its my guess
i think this rule dont apply to breast abscess esp in lactating women

Needle aspiration may be considered for abscesses less than 3 cm in size.[1, 17, 19, 20] http://emedicine.medscape.com/articl...reatment#a1126

Delayed treatment of mastitis can lead to abscess formation, and it can be prevented by early antibiotic therapy. Ultrasonography is helpful for detecting abscess formation. In selected cases the abscess can be drained with needle aspiration with excellent cosmesis.http://www.ncbi.nlm.nih.gov/pubmed/12616423
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B. Nonsteroidal anti-inflammatory drugs (NSAIDs) and warm compresses only
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Ultrasound-guided needle aspirations can be performed on abscesses smaller than 3 cm; however, evidence in the literature shows that abscesses greater than 3 cm treated with needle aspiration have a high reoccurrence rate and may need further incision and drainage.[17, 18, 19]

For many years, I&D has been the standard of care for abscesses. Although I&D has a lower reoccurrence rate, it is more invasive than needle aspiration and frequently results in scarring with poor cosmetic outcomes.
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Originally Posted by mbbs2010 View Post
B. Nonsteroidal anti-inflammatory drugs (NSAIDs) and warm compresses only
That's for masitis. If there is pus you have to drain it one way or another.

Small abscess <3cm-----------Needle aspiration
Recurrence after needle aspiration or >3cm -----------I&D
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Originally Posted by Novobiocin View Post
That's for masitis. If there is pus you have to drain it one way or another.

Small abscess <3cm-----------Needle aspiration
Recurrence after needle aspiration or >3cm -----------I&D
this is qbank expln...

Option C (Oral cephalexin and surgical incision and drainage) is correct. Incision and drainage is historically the preferential initial treatment for a fluctuant breast abscess. Simple incision and drainage does not treat the underlying cause of the breast abscess, and it may result in a high number of recurrences.

Option A (Needle aspiration only) is incorrect. The consensus is that needle aspiration is not an appropriate treatment for breast abscesses. Incision and drainage is required and should be performed by a surgeon because multiple aspirations over time are necessary for complete resolution.


so?
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I&D will hv very bad & ugly scarr and the evidence-based as mentioned above used only in recurrence, or >3cm which is rare, and of-course this will be combined by abx

Last edited by bisho; 05-30-2012 at 08:57 AM.
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Originally Posted by tyagee View Post
this is qbank expln...

Option C (Oral cephalexin and surgical incision and drainage) is correct. Incision and drainage is historically the preferential initial treatment for a fluctuant breast abscess. Simple incision and drainage does not treat the underlying cause of the breast abscess, and it may result in a high number of recurrences.

Option A (Needle aspiration only) is incorrect. The consensus is that needle aspiration is not an appropriate treatment for breast abscesses. Incision and drainage is required and should be performed by a surgeon because multiple aspirations over time are necessary for complete resolution.


so?
Agreed but if given the size aspiration could be a choice along with abs.
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