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Cited by 78Breastfeeding Practices and InfluencesBreast Lesions and CarcinomasBreast Implant and Reconstruction

Treatments for breast abscesses in breastfeeding women

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Irusen, Hayley, Rohwer, Anke C, Steyn, D Wilhelm, Young, Taryn·2015·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd010490.pub2PMC PMC9226721
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Abstract

BACKGROUND: The benefits of breastfeeding are well known, and the World Health Organization recommends exclusive breastfeeding for the first six months of life and continuing breastfeeding to age two. However, many women stop breastfeeding due to lactational breast abscesses. A breast abscess is a localised accumulation of infected fluid in breast tissue. Abscesses are commonly treated with antibiotics, incision and drainage (I&D) or ultrasound-guided needle aspiration, but there is no consensus on the optimal treatment. OBJECTIVES: To assess the effects of different treatments for the management of breast abscesses in breastfeeding women. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trial Register (27 February 2015). In addition we searched African Journals Online (27 February 2015), Google Scholar (27 February 2015), ProQuest Dissertations and Theses Databases (27 February 2015) and the WHO International Clinical Trials Registry Platform (ICTRP) search portal (27 February 2015). We also checked reference lists of retrieved studies and contacted experts in the field as well as relevant pharmaceutical companies. SELECTION CRITERIA: Randomised controlled trials (RCTs) investigating any intervention for treating lactational breast abscesses compared with any other intervention. Studies published in abstract form, quasi-RCTs and cluster-RCTs were not eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion, assessed risk of bias and extracted data. Data were checked for accuracy. MAIN RESULTS: We included six studies. Overall, trials had an unclear risk of bias for most domains due to poor reporting. Two studies did not stratify data for lactational and non-lactational breast abscesses, and these studies do not contribute to the results. This review is based on data from four studies involving 325 women. Needle aspiration (with and without ultrasound guidance) versus incision and drainage (I&D) Mean time (days) to complete resolution of breast abscess (three studies) - there was substantial heterogeneity among these data (Tau(2) = 47.63, I(2) = 97%) and a clear difference between subgroups (with or without ultrasound guidance; Chi(2) = 56.88, I(2) = 98.2%, P = < 0.00001). We did not pool these data in a meta-analysis. Two studies excluded women who had treatment failure when they calculated the mean time to complete resolution. One study found that the time to complete resolution of breast abscess favoured needle aspiration over I&D (mean difference (MD) -6.07; 95% confidence interval (CI) -7.81 to -4.33; n = 36), but excluded 9/22 (41%) women in the needle aspiration group due to treatment failure. Another study reported faster resolution in the needle aspiration group (MD -17.80; 95% CI -21.27 to -14.33; n = 64) but excluded 6/35 (17%) women in the needle aspiration group due to treatment failure. A third study also reported that needle aspiration was associated with a shorter time to complete resolution of breast abscess (MD -16.00; 95%CI -18.73 to -13.27; n = 60); however, the authors did not indicate the number of women who were lost to follow-up for either group, and it is unclear how many women contributed to this result. Considering the limitations of the available data, we do not consider the results to be informative. Continuation of breastfeeding, after treatment (success): results favoured the needle aspiration group, but we did not pool data from the two studies because of substantial unexplained heterogeneity (I(2) = 97%). One study reported that women in the needle aspiration group were more likely to continue breastfeeding (risk ratio (RR) 2.89; 95% CI 1.64 to 5.08; n = 60), whereas the other study found no clear difference (RR 1.09; 95% CI 0.97 to 1.22 n = 70). Treatment failure was more common among women treated with needle aspiration compared to those who underwent I&D (RR 16.12; 95% CI 2.21 to 117.73; two studies, n = 115, low quality evidence). In one study, treatment with needle aspiration failed in 9/22 women who subsequently underwent I&D to treat their breast abscess. In another study, treatment with needle aspiration failed in 6/35 women, who subsequently underwent I&D. All abscesses in the I&D group were successfully treated.The included studies provided limited data for the review's secondary outcomes. No data were reported for adverse events. One study (60 women) reported that women in the needle aspiration group were more satisfied with their treatment than women who received I&D to treat their breast abscesses. Incision and drainage (I&D) with or without antibioticsOne study (150 women) compared the value of adding a broad-spectrum cephalosporin (single dose or a course of treatment) to women who underwent I&D for breast abscesses.The mean time to resolution of breast abscess was reported as being similar in all groups (although women with infection were excluded). Mean time to resolution f

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  1. Peters F, Flick‐Filliés D. Drainage of large breast abscesses with reference to esthetic and functional aspects. Geburtshilfe und Frauenheilkunde 1991;51(11):901‐4. [DOI] [PubMed] [Google Scholar]
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Authors
Irusen, H., Rohwer, A. C., Steyn, D. W., & Young, T.
Affiliations
  • Stellenbosch University (ZA)
  • South African Medical Research Council (ZA)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2015-08-17
Volume
2015
Issue
8
Pages
CD010490-CD010490
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd010490.pub2
PMC
PMC9226721
OpenAlex
W2130336997
Cited by
76
References
64
Citations by year
2026: 1 · 2025: 5 · 2024: 6 · 2023: 10 · 2022: 14 · 2021: 6 · 2020: 10 · 2019: 10 · 2018: 7 · 2017: 3 · 2016: 2 · 2015: 1 · 2014: 1
FWCI
0.56
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • SUNScholar (Stellenbosch University) (submittedVersion)
Funders
  • Government of the United Kingdom
  • National Institute for Health and Care Research
  • Department for International Development
  • Evidence Synthesis Programme
Topics
  • Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Breast Lesions and Carcinomas
  • Health Sciences › Medicine › Surgery › Breast Implant and Reconstruction
Keywords
breastfeeding, incision and drainage, ultrasound-guided aspiration, antibiotics, treatment failure, breastfeeding cessation, risk of bias in trials, treatment effect heterogeneity, safety and tolerability, cost-effectiveness, quality of life, patient satisfaction, patient-reported outcomes
MeSH terms
Abscess, Adult, Breast Diseases, Breast Feeding, Cephalosporins, Drainage, Female, Humans, Mastitis, Randomized Controlled Trials as Topic, Treatment Failure, Ultrasonography, Interventional, Biopsy, Fine-Needle

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