Negative Suction Drain Through a Mini Periareolar Incision for the Treatment of Lactational Breast Abscess Shortens Hospital Stay and Increases Breastfeeding Rates

Introduction

Lactational breast abscess, normally as a consequence of mastitis, affects 0.4–11% of breastfeeding women. ¹ Traditional incision and drainage causes scars and frequent discontinuation of breastfeeding. This article reports a new strategy of applying drain with negative suction pressure through a mini periareolar incision, which successfully eliminated the abscess and prevents the cessation of breastfeeding.

A retrospective analysis of 62 mothers who were hospitalized from August 2012 to April 2015 with a diagnosis of breast abscess was studied. Inclusion criteria included complete records, primiparity, lactational, ultrasound confirming a single abscess (multilocular included), no skin necrosis, nor other companied illness. Thirty-two patients had traditional incision and drainage (Group A), and in 30 patients, drain with negative suction pressure through mini periareolar incision was applied (Group B). According to medical records, patients chose their specific type of surgery after fully understanding the pros and cons of treatment.

For Group A patients, an incision, about 3–6 cm, was made directly over the point of maximal swelling, loculations were digitally broken down, the pus was completely drained out from the cavity that was repeatedly irrigated, and the wound was packed open with gauze. The dressings were changed on a daily basis until there was wound granulation with no pus.

For Group B patients, a periareolar 0.5 cm incision closest to the abscess under local anesthesia was made. The incision passed through the skin and the superficial fascia. Then a long artery forceps was inserted along the surface of the gland into the cavity that broke all loculi with the point of the artery forceps. With the guidance of the artery forceps, a F14 or F16 drain tube was placed into the abscess cavity, connected to a negative pressure drainage bottle, and fixed to the skin with a suture. The drain was left in situ and cared every 2–3 days. The drain was removed until drainage subsided and no residual fluid accumulation showed on the ultrasound.

All patients were encouraged to continue breastfeeding and empty the breast as fully as possible or wean gradually if they chose to stop breastfeeding. The patients were discharged when there was clinical resolution of the infection and local symptoms and no further pus from the cavity. Group A patients returned to the ward for wound care 3–4 times per person. Group B patients returned for follow-up 1 month later. After a follow-up for 3 months, no recurrence was observed and no infection of the infants occurred.

All the clinical data were analyzed between the two groups as shown in Table 1.

The length of hospital stay was 3.1 days shorter for Group B patients (p = 0.003). All the patients in Group A and two patients in Group B chose to cease breastfeeding, leading to the rate of continued breastfeeding significantly higher in Group B (p < 0.005).

Mastitis occurs in as much as 20% of breastfeeding mothers, and if not managed expeditiously, it may progress into breast abscess and then into milk fistulae. Although breast abscess is a serious uncommon complication of mastitis with high morbidity rate, there is a lack of evidence to demonstrate the optimal treatment option. Traditional incision and drainage has been the golden standard for treating abscess. It requires a 4–5 cm incision, leading to open wound, regular postoperative dressing changes, and thus a long healing time. On the contrary, for patients in Group B, with a negative pressure drain through mini periareolar incision, undemanding dressing change and rapid healing cut down the hospital stay significantly. The application of negative suction pressure keeps the wound clean and forms a hostile microenvironment.

Patients in Group A experienced great pain during every treatment procedure. This undoubtedly aroused fear, anxiety, helplessness, and depression, which could well have led to a decrease in the quantity of breastmilk and termination of breastfeeding. ²

Academy of Breastfeeding Medicine Protocol Committee encourages mothers to continue breastfeeding with mastitis and/or breast abscess since there is no evidence of risk of harm to a healthy infant feeding from an infected breast. ³ However, Branch-Elliman et al. found that about 41% of women chose to stop breastfeeding due to the infection. ⁴ In our study, 54.8% of patients discontinued breastfeeding, 100% in Group A and 6.7% in Group B. We attribute the high rate of breastfeeding cessation to the following items: (1) the mothers failed to feed due to the long duration and pain of the treatment, as previously mentioned, (2) the babies refused to suckle the affected breast because of change in odor or skin texture, and (3) some families believe, wrongly, that the antibiotics would harm the baby and dissent from breastfeeding after infection.