You are on page 1of 3


Aspiration of Breast Abscess through Wide Bore

14-Gauge Intravenous Cannula
Shahida Parveen Afridi, Shams Nadeem Alam and Saman Ainuddin

Objective: To aspirate breast abscess through a wide bore (14-gauge) intravenous (I/V) cannula and determine its
efficacy in terms of the number of recurrences and number of aspirations.
Study Design: Case series.
Place and Duration of Study: Dow University of Health Sciences and Civil Hospital and Bantva Hospital, Karachi,
Pakistan, from January 2009 to December 2011.
Methodology: Patients with breast abscesses confirmed on ultrasound without skin ulceration were selected. The soft
area of breast abscess with positive fluctuation was marked and fixed with index finger and thumb. A 14-gauge cannula
was inserted. Pus was aspirated through a 50 cc syringe, repeated till no aspirate could be obtained. All patients were
followed weekly for 4 weeks, clinically for size of lump, local tenderness and temperature, while complete resolution was
confirmed on ultrasound, as resolution of the lesion.
Results: A total of 55 patients were included in this study. Mean age was 29 5.58 years while ranging from 20 - 40 years.
Complete resolution of abscess was seen in 31 (56.4%) cases by single aspiration. Second aspiration was required in 24
(43.6%) patients and third aspiration in single setting was required in one case only. Recurrence after the second
aspiration occurred in 08 (14.5%). Incision drainage was required in 7 (12.7%) patients.
Conclusion: Percutaneous aspiration of breast abscess through a wide bore (14-gauge) I/V cannula is a simple
alternative to incision and drainage.

Key Words: Breast abscess. Needle aspiration. Percutaneous aspiration. Incision and drainage. 14-gauge wide bore I/V cannula.

INTRODUCTION without ultrasound guidance is an easy outpatient

Breast abscess is a localized collection of pus in the department procedure and saves patients from incision-
breast, most commonly seen in lactating women.1 It may drainage under general anesthesia with good cosmesis.
result as a complication of mastitis caused by the micro- The objective of this study was to aspirate the breast
organism Staphylococcus aureus.2 Nipple piercing by a abscess through a wide bore 14-gauge I/V cannula and
child during feeding is also an important cause of determine its efficacy through number of recurrences
breast abscess.3 The incidence of breast abscess is and number of aspirations.
10.2%.4,5 Percutaneous aspiration of breast abscess is
a simple alternative to incision drainage, which requires METHODOLOGY
daily dressing, difficulty in breast feeding and prolonged This cross-sectional interventional study was conducted
healing time with ugly scar.6 Incision drainage is at the Department of General Surgery, Dow University of
indicated in complicated breast abscess, with skin Health Sciences and Civil Hospital (DUHS and CHK)
involvement ulceration, necrosis, ruptured and recurrent and Bantva Hospital, Karachi, Pakistan, from January
breast abscess.7 2009 to December 2011. Patients with breast abscess
Ultrasound guided repeated aspiration of breast without skin involvement ulceration and necrosis,
abscess is an established modality as an alternative to irrespective of the volume and size diagnosed clinically
incision drainage in breast abscess, without skin and confirmed on ultrasound breast were selected for
ulceration and necrosis.8 Non-surgical method should this study. Complicated breast abscess presenting with
be the first line treatment option.9 Aspiration of breast skin changes, ulceration, necrosis, gangrene, ruptured
abscess through wide bore intravenous (I/V) cannula and recurrent breast abscess, and tuberculosis were
excluded from the study.
Department of General Surgery, Dow University of Health Sciences
The procedure was performed on a day-care basis.
and Civil Hospital, Karachi.
Informed consent was taken about the procedure and its
Correspondence: Dr. Shahida Parveen Afridi, Flat No 3, pros and cons were explained to the patient. The area
2nd Floor, 10-C, 19th Commercial Street, Phase II Ext. DHA, that was soft, tender with positive fluctuation was
Karachi. marked with skin marker and breast was cleaned with
E-mail: pyodine solution. Abscess was fixed with index finger
Received: April 02, 2012; Accepted: May 17, 2014. and thumb, 14-gauge I/V cannula was inserted and

Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (10): 719-721 719
Shahida Parveen Afridi, Shams Nadeem Alam and Saman Ainuddin

needle was withdrawn, a 50 cc syringe was applied to painful lump, same size of the abscess and fever.
the I/V cannula and pus was aspirated. Syringe was Maximum amount of pus aspirated was 300 cc.
detached, emptied into the container and again Bromocriptine (prolactin inhibitor) 5 mg twice a day was
reattached with the cannula and abscess was re- given to 12 (21.8%) patients to suppress milk production
aspirated. This procedure was repeated till the cavity in lactating mothers for a period of one week; remaining
was empty. Conservative treatment antibiotics and lactating mothers (n=10, 18.2%) were allowed to
analgesic were given to the patients as a supportive continue the lactation. Analgesic and antibiotic were
measure where indicated. Prolactin inhibitor was given given in 41 (74.5%) patients as a supportive measure
only in lactating mothers for a period of one week and (Table II).
additional manual expression of milk or emptying by Table II: Number of aspiration and incision drainage.
breast pump was also advised. This procedure was Variable Number Percentage
repeated again in patients presented with recurrence First aspiration 55 100
after a period of one or two weeks. Incision and drainage Resolved 31 56.3
was required in recurrent cases after multiple aspiration. Recurrence 24 43.6
All patients were followed for a period of 4 weeks Second aspiration 24 43.6
clinically for size of lump, local tenderness and Resolved 16 29.0
temperature. Ultrasound breast was performed in all Recurrence 08 14.5
patients at 4th week to confirm the complete resolution Third aspiration 01 01.8
of abscess. Incision and drainage 07 12.7
Conservative treatment after aspiration for a week 41 74.5
Data was collected and recorded on a pre-designed Analgesic +antibiotic 29 52.7
research proforma. SPSS version 17 was used to Bromocriptine 5 mg /twice a day for a week
analyze the data. Mean and standard deviation were (lactating mother) 12 21.8
calculated for numerical variable while frequency and No conservative treatment 14 25.5
percentages were computed for categorical variable.
Breast abscess was noticed in younger age group in this
Mean age was 29 5.58 years, while overall age ranged series as supported by another study.10 Primiparous
from 20 - 40 years. The duration of symptoms before women are more prone to the development of breast
presentation was 7 - 10 days. Right breast was affected abscess than multiparous women.11 Lactation is also a
in 34 (61.8%) while left breast was affected in 21 risk factor for the development of breast abscess.12
(38.2%) patients. Other demographic and associated
Mastitis puerperalis may frequently be complicated by a
features are given in Table I.
breast abscess.13 Diabetics can present with breast
Breast abscess in 31 (56.4%) patients was resolved on abscess in non-lactating women.14
single aspiration, second aspiration was required in 24
Radiology has a pivotol role in the diagnosis of breast
(43.6%) where it resolved in 16 (29%) patients.
abscess in addition to the clinical diagnosis.15 Most of
Recurrence was noticed in 8 (14.5%) patients after
the patients were diagnosed clinically supported by
second aspiration, out of whom only one patient was
ultrasound in this series. Ultrasound is the best and
managed by third aspiration, while 7 (12.7%) patients
simple modality to diagnose the breast abscess.16 MR
were managed by incision-drainage because of the
imaging and MR spectroscopy also have a role in
Table I: History examination and investigation. findings of multiple breast abscess.17 High resolution
Variable Number Percentage MRI has potential diagnostic value in sub-areolar breast
History abscess. These latter techniques are expensive and
H/O painful breast lump with fever 55 100 were not performed in this series; however, these can be
Unmarried 12 21.8 used to guide surgery with the aim of reducing the
Married 43 78.1 recurrence rate.18
Primi-para 14 25.5
Multi-para 29 52.7
Immediate diagnosis and treatment is necessary if
Lactating 22 40.0 breast feeding is to be continued and for the prevention
Non lactating 33 60.0 of further complications.19 Most abscesses are treated
Pregnant 04 07.2 with ultrasound guided aspiration in combination with
Recurrence 08 14.5 supportive treatment, antibiotic, analgesic, reassurance
Examination and proper counselling. Non-operative treatment of
Palpable lump, tender, warm, breast abscess with aspiration and antibiotics has been
soft cystic, positive fluctuation 55 100 reported with high success rates.20 Management of
Investigation lactational breast infections include symptomatic treat-
Ultrasound breast 55 100 ment, reassurance, emotional support, education and

720 Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (10): 719-721
Aspiration of breast abscess through wide-bore cannula

support for breast feeding. Emptying of the breast, by 8. Delaloye JF, Capoccia Brugger R, Ifticene Treboux A, Anaye A,
breast feeding every 2 hours and in some cases Meuwly JY. Ultrasonography-guided drainage should be
considered as the first-line approach for the treatment of breast
additional manual expression or by breast pump.21
abscess. Rev Med Suisse 2010; 6:2010-2.
Percutaneous aspiration is simple, safe, effective and
better alternative to incision and drainage performed as 9. Elder EE, Brennan M. Non-surgical management should be
first-line therapy for breast abscess. World J Surg 2010; 34:
an outpatient department procedure without anes-
2257-8; author reply 9.
thesia.7 Treatment of loculated lactational breast
abscess with a vacuum biopsy system is another option 10. Beyrouti MI, Boujelben S, Beyrouti R, Ben Amar M, Abid M,
Louati D, et al. Pyogenic abscess of the breast: clinical and
for breast abscess reported in the literature not used in
therapeutic aspects. Gynecol Obstet Fertil 2007; 35:645-50.
these cases.22 Surgical incision-drainage is no longer
the recommended first line treatment now, as used 11. Kvist LJ, Rydhstroem H. Factors related to breast abscess
after delivery: a population-based study. BJOG 2005; 112:
previously.6 Non-surgical management of breast
abscess is an established first option for the treatment of
breast abscess.23 Amoxicillin-clavulanate was used 12. Martin JG. Breast abscess in lactation. J Midwifery Womens
Health 2009; 54:150-1.
empirically without culture and sensitivity after aspiration
as a supportive measure in this series. Use of 13. Rogmans G. Mastitis puerperalis. Zentralbl Gynakol 2003;
flucloxacillin with or without metronidazole (or
amoxicillin-clavulanate as a single preparation) is also 14. Verghese BG, Ravikanth R. Breast abscess, an early indicator
reported as an initial empirical therapy.24 for diabetes mellitus in non-lactating women: a retrospective
study from rural India. World J Surg 2012; 36:1195-8.

CONCLUSION 15. Trop I, Dugas A, David J, El Khoury M, Boileau JF, Larouche

N, et al. Breast abscesses: evidence-based algorithms for
Percutaneous aspiration of breast abscess through diagnosis, management, and follow-up. Radiographics 2011;
wide bore 14-gauge I/V cannula without ultrasound 31:1683-99.
guidance is an easy and outpatient department 16. Shah G, Jankharia B. Pictorial essay: breast USG. Indian J
procedure. It is a better alternative to incision drainage Radiol Imaging 2010; 20:98-104.
with good cosmesis and saves the patients from surgery
17. Anik Y, Inan N, Sarisoy HT, Arslan AS, Demirci A. MR imaging
and general anesthesia. and MR spectroscopy findings of multiple breast abscess in
the non-lactating case. Breast J 2007; 13:527-8.
REFERENCES 18. Fu P, Kurihara Y, Kanemaki Y, Okamoto K, Nakajima Y, Fukuda
1. Ulitzsch D, Nyman MK, Carlson RA. Breast abscess in lactating M, et al. High-resolution MRI in detecting subareolar breast
women: US-guided treatment. Radiology 2004; 232:904-9. abscess. AJR Am J Roentgenol 2007; 188:1568-72.
2. Hagiya H, Shiota S, Sugiyama W, Otsuka F. Postpartum breast 19. Cignacco E, Zbinden A, Surbek D. Ongoing breastfeeding with
abscess caused by community-acquired methicillin-resistant breast abscess. Pflege 2006; 19:70-2; discussion 3-8. German.
Staphylococcus aureus in Japan. Breastfeed Med 2014; 9:45-6.
20. Rageth CJ, Ricklin ES, Scholl B, Saurenmann E. Conservative
3. Leibman AJ, Misra M, Castaldi M. Breast abscess after nipple treatment of puerperal breast abscesses with repeated
piercing: sonographic findings with clinical correlation. sonographically guided aspirations and oral antibiotic
J Ultrasound Med 2011; 30:1303-8. administrations. Z Geburtshilfe Neonatol 2004; 208:170-3.
4. Amir LH, Forster D, McLachlan H, Lumley J. Incidence of 21. Cusack L, Brennan M. Lactational mastitis and breast abscess -
breast abscess in lactating women: report from an Australian diagnosis and management in general practice. Aust Fam
cohort. BJOG 2004; 111:1378-81. Physician 2011; 40:976-9.
5. ZMK, Jamal S, Khaliq T, Shabbir S. The frequency of various 22. Thrush S, Dixon JM. Treatment of loculated lactational breast
causes of breast lumps in females presenting to surgical OPD abscess with a vacuum biopsy system. Br J Surg 2005; 92:
in a tertiary care hospital. Ann Pak Inst Med Sci 2013; 9:26-9. 1225-6. Br J Surg 2006; 93:251; author reply 2.
6. Naeem M, Rahimnajjad MK, Rahimnajjad NA, Ahmed QJ, 23. Hansen PB, Axelsson CK. Treatment of breast abscess. An
Fazel PA, Owais M. Comparison of incision and drainage analysis of patient material and implementation of recommen-
against needle aspiration for the treatment of breast abscess. dations. Ugeskr Laeger 2003; 165:128-31.
Am Surg 2012; 78:1224-7.
24. Dabbas N, Chand M, Pallett A, Royle GT, Sainsbury R. Have
7. Berna-Serna JD, Madrigal M. Percutaneous management of the organisms that cause breast abscess changed with time?
breast abscesses. An experience of 39 cases. Ultrasound Med Implications for appropriate antibiotic usage in primary and
Biol 2004; 30:1-6. secondary care. Breast J 2010; 16:412-5.

Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (10): 719-721 721