Breast abscess: The Daily PANCE Blueprint

Home Breast abscess: The Daily PANCE Blueprint

Breast abscess: The Daily PANCE Blueprint

A 35-year-old female who is 3 weeks postpartum presents with severe pain and swelling in her right breast for the past few days. She reports fever and chills. On exam, the right breast is markedly erythematous and edematous with an area of dark discoloration and thinning of the overlying skin. A fluctuant mass is palpable beneath this area, and purulent discharge can be expressed from the nipple. Which of the following is the most appropriate management?

A. Continue breastfeeding and start oral dicloxacillin
B. Perform ultrasound-guided needle aspiration and prescribe cephalexin
C. Apply warm compresses and monitor for spontaneous drainage
D. Surgical incision and drainage plus antibiotics
E. IV antibiotics and IV fluids alone

Answer and topic summary

The answer is D. Surgical incision and drainage plus antibiotics

A breast abscess is essentially a localized region of infection/pus in the breast tissue. It is usually seen as a complication of mastitis. Clinical features include breast pain, edema, fever, fluctuant mass, purulent nipple discharge, etc. Diagnosis is often clinical, but a breast ultrasound can be obtained. For uncomplicated abscesses, percutaneous needle aspiration is the first line. Patients should always be placed on antibiotics. If the patient has risk factors for MRSA, clindamycin or Bactrim should be given. It’s important to note that surgical incision and drainage are the treatments for breast abscesses complicated by skin necrosis or extensive infection.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Reproductive System ⇒ Breast Disorders ⇒ Breast abscess

Also covered as part of the Women's Health Rotation and Emergency Medicine Rotation topic lists

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