Ultrasound-Guided Needle Aspiration vs. Surgical Incision and Drainage of Breast Abscesses: Our Experience at a Tertiary Care Centre in North India

TL;DR

This study compares ultrasound-guided needle aspiration and surgical drainage for breast abscesses, finding that aspiration offers better cosmetic results and is more cost-effective.

Contribution

The study provides a comparative analysis of two breast abscess treatments in a North Indian tertiary care setting.

Findings

Ultrasound-guided aspiration had better cosmetic outcomes and lower scarring compared to surgical drainage.

Recurrence was slightly higher with aspiration, but most cases were managed with repeat procedures.

Aspiration was found to be more cost-effective and preferable for both puerperal and non-puerperal abscesses.

Abstract

Background

For women, breast abscesses are a common morbidity and an emergency. It typically affects women who are breast feeding/nursing. The traditional approach to treating a breast abscess involved making a surgical incision and draining the abscess. This procedure was closely linked to the requirement for general anaesthesia, a lengthy recovery period, frequent dressing changes, challenges with breastfeeding, and potentially disappointing cosmetic results. Ultrasonography is a valuable diagnostic tool that helps to identify breast abscesses, directs the positioning of the needle during aspiration, and allows for the detection of many abscess loculations, all of which are helpful when aspirating breast abscesses with a needle.

Methods

This prospective comparative study was conducted in the Department of General and Minimal Invasive Surgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), to compare surgical incision and drainage with ultrasound (US)-guided needle aspiration in patients with breast abscesses during a two-year period. All the involved patients were screened, and a detailed history and physical examination was collected. Diagnosis of breast abscess was made after confirming by ultrasonography of both breasts. The study participants were randomized into two groups after having their full written informed consent for both types of interventions.

Results

Out of 118 patients, 60 (50.8%) underwent surgical incision and drainage, and 58 (49.2%) underwent ultrasound-guided needle aspiration. Most patients were in the reproductive age group (30-40 years), and lactating women constituted a substantial proportion in both groups. Recurrence was observed more frequently in the ultrasound-guided aspiration group (12.0%) compared to the incision and drainage group (5.0%); however, most recurrences in the aspiration group were successfully managed with repeat aspirations. The incision and drainage group had a significantly higher mean duration of illness (10.36 ± 2.50 vs. 8.06 ± 2.83 days; p=0.012) and a higher incidence of fistulization and significant scarring. Cosmetic outcomes were significantly better in the ultrasound-guided aspiration group, with lower rates of disfigurement (p<0.05)

Conclusion

It was concluded that USG-guided aspiration of breast abscess is a better and more cost-effective intervention as compared to surgical incision and drainage as a treatment option in the management of breast abscesses for both puerperal and non-puerperal breast abscesses.

Figures