Surgical drainage of lactational breast abscess with ultrasound-guided Encor vacuum-assisted breast biopsy system

Surgical management of a giant fibroadenoma during lactation

Fibroadenomas are the most common breast lesion in women of reproductive age. During pregnancy and lactation, fibroadenomas can undergo rapid growth in response to hormonal stimulus. These changes may prompt further investigation and/or intervention due to the risk of an underlying phyllodes tumour. We present a case of a female patient who underwent surgical excision of a giant fibroepithelial lesion at 4 months post partum while continuing to breastfeed. The lesion was successfully excised while maintaining lactation. A postoperative milk fistula resolved with non-operative management. There is limited literature on the surgical management of breast lesions in lactating women. This case illuminates the surgical management of breast lesions in an often well informed group of patients who may choose to have surgery while lactating in spite of the increased risk of complications. This case also highlights the need for a holistic approach to maintain the overall health of mother and child.

Percutaneouse ultrasound-guided needle aspiration for management of breast abscesses - a review

Breast abscesses are still a common cause of morbidity among lactational females. Over the years, there has been an increase in the incidence of non-lactational breast abscesses and a decrease in lactational breast abscesses. The management could be the use of the conventional method of surgical incision and drainage or the newer techniques of needle aspiration or suction drain or catheter in addition to the administration of antibiotics. The use of needle aspiration as the minimal-invasive conservative technique is generally recommended for abscesses less than 3-5 cm in diameter. However, recent studies have compared the two methods for abscesses larger than 3 cm and among patients with risk factors for breast abscesses. We aim to present the clinical evidence showing the comparison between needle aspiration and incision and drainage for breast abscesses irrespective of the size of the abscesses. There is a lack of comparative information on the two treatment modalities for breast abscesses larger than 3 cm in diameter; however, needle aspiration is being tried because of its advantages like cosmetic preference, short hospital stay and healing time, and no stoppage of breastfeeding.

Application of arthroscopic system in the treatment of lactational breast abscess

Purpose

Optimal treatment of breast abscesses has been controversial. Herein, we report an innovative method for the operative treatment of lactational mammary abscesses.

Methods

Nineteen lactating patients diagnosed with breast abscesses were enrolled in the study, and abscess debridement and drainage were performed using an arthroscopic system. The clinical characteristics of the patients were recorded to evaluate the feasibility, efficacy, and cosmetic results of arthroscopic surgery for breast abscesses.

Results

All 19 patients were cured and did not relapse within the 6-month-follow-up period. One patient stopped breastfeeding due to breast leakage. All patients were satisfied with the postoperative appearance of the breast.

Conclusion

Arthroscopic debridement and drainage are effective treatment methods for lactational breast abscesses, with a high cure rate, few complications, and satisfactory cosmetic outcomes.

Initiating and Supporting Breastfeeding: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives

Exclusive breastfeeding is recommended for children for the first 4 to 6 months of life, with complementary foods added thereafter. It is the most ecological way of protecting the child's and mother's health. Training of health professionals is required to avoid transmitting inconsistent information in 3 areas: 1) implementing these 3 predictors: safe skin-to-skin, first breastfeed, and rooming-in 24/7; 2) teaching and monitoring: i) early signs of waking and feeding rhythms, ii) positioning and latching, and iii) signs of effective transfer; and 3) referring women to specialized support services if difficulties arise (eg, inadequate milk production, pain, cracked nipples, engorgement). Breastfeeding should continue during mastitis or an abscess. Ultrasound-guided needle aspiration is beneficial in treating an abscess. Précis: Information is provided to enable health professionals to better support breastfeeding and help women with the most common difficulties, thus promoting breastfeeding initiation and duration.

Exploring the Efficacy of Comprehensive Management of Breast Abscesses in Restoring Milk Volume

BACKGROUND

Approximately 54.8% of patients with breast abscesses discontinue breastfeeding due to the lack of adequate breastfeeding support.

RESEARCH AIMS

We aimed to (1) examine the difference in milk volume produced by healthy breasts and breasts with abscesses; and (2) to explore the changes in milk volume before and after comprehensive management.

METHOD

A prospective, consecutive series study was designed. Lactating patients (N = 50) with breast abscesses were selected from March 2017 to November 2018. The volume and frequency of milk expression of the affected and the unaffected breast were recorded every 24 hr before and after comprehensive management. The difference in the milk volume produced by healthy breasts (control) and breasts with abscesses, as well as the milk volume produced by each breast before and after comprehensive management, was determined.

RESULTS

There was a significant difference in the milk volume produced by healthy breasts and breasts with abscess before (t = 3.016; p = .004) and after (t = 4.336; p < .001) comprehensive management. The frequency of milk expression was significantly higher after comprehensive management than before it (z = -6.145; p < .001); the milk volume produced by each side significantly increased after comprehensive management (healthy breasts: t = -4.789; p < .001; breasts with abscess: t = 2.555; p = .014).

CONCLUSION

The total milk volume produced by breasts with abscesses can be less than that produced by healthy breasts. The management of abscesses by increasing the frequency of milk expression and degree of emptying can help mothers increase their milk volume.

Clinical characteristics of lactational breast abscess caused by methicillin-resistant Staphylococcus aureus: hospital-based study in China

Background

This study aimed to identify the differences in clinical characteristics, puncture efficacy, antibiotic use, treatment duration, breastfeeding post-illness, and recurrence of patients with breast abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-susceptible Staphylococcus aureus (MSSA) infection during lactation.

Methods

The clinical data of patients with breast abscesses during lactation who were treated from January 2014 to February 2017 at Haidian Maternal and Child Health Hospital, Beijing, were reviewed. According to bacterial culture results, they were divided into MRSA (n = 260) and MSSA (n = 962) groups. Hospitalization (whether or not the patients were hospitalized), postpartum period, maternal age, location of abscess cavities, number of abscess cavities, amount of pus, frequency of needle aspiration, failure of needle aspiration, antibiotic use, treatment duration, cessation of breastfeeding and recurrence were compared between the two groups using a t-test and a chi-squared test.

Results

We noted that only the cessation of breastfeeding was statistically significantly different between the two groups (P = 0.018). Hospitalization, postpartum period, maternal age, location of abscess cavities, number of abscess cavities, amount of pus, number of needle aspiration, failure of needle aspiration, antibiotic use, treatment duration and recurrence showed no statistically significant differences (P = 0.488, P = 0.328, P = 0.494, P = 0.218, P = 0.088, P = 0.102, P = 0.712, P = 0.336, P = 0.512, P = 0.386 and P = 0.359, respectively).

Conclusions

There was no difference in clinical characteristics between breast abscesses infected by MRSA and those infected by MSSA. Ultrasound-guided needle aspiration could be the first choice for MRSA-infected breast abscess treatment. There is no need to increase antibiotic use because of MRSA infection, unless it is necessary. The reason why more patients with MRSA infected breast abscesses terminated breastfeeding is unclear from this study.

ROLE OF MINI-INVASIVE SURGERY IN TREATMENT OF LACTATION MASTITIS

Introduction. Lactation mastitis is not a rear pathology. It is observed at every tenth parturient woman, mainly in the case of premature termination of breastfeeding. When analyzing the structure of postpartum purulent-inflammatory complications, most researchers report about high frequency lactational mastitis (in 26-67% cases). The technique of conducting wide incisions to drain the breast abscess and drug cessation of lactation was adopted to treat lactational abscess.

Purpose. Specify the location for minimally invasive surgical techniques (puncture and drainage of the nidus of infection under ultrasound guidance) in the complex treatment of lactational abscesses of the mammary glands.

Materials and methods. 64 parturient women suffering from verified lactation abscesses were observed. Average age of patients was 24,9±4,5 years (from 21 to 44). The research was carried out during 3 years: from 2018 to 2020. All patients were on outpatient treatment and under observation. Conservative and surgical (minimally invasive) methods of breast abscess treatment were applied. Puncture of the lactation abscess was carried out with a thick needle (18g «pink»), at the greatest distance from the areola, after expressing / feeding.

Results. 41% of breast abscesses occurred during lactation up to 1 month, while in 34% of cases, the period of lactation was in the range from 1 to 3 months. In 16% of patients, an abscess formed during lactation from 3 to 7 months, in 7% of cases - from 7 to 18 months. Duration of breastfeeding was investigated at the 3rd day, 3rd week and 12th week after surgery. Breastfeeding was interrupted on women’s request. As a result we found out, that minimally invasive (puncture, drainage) surgical methods for treating breast abscesses should be prioritized at complex treatment programs for lactational mastitis.

Local Complications of Breast Surgery during Pregnancy and Lactation

During pregnancy and lactation, breast vascularity increases and edema occurs in the breast . As a consequence, rate of complications of breast biopsy and surgery like bleeding, infection, delayed healing and wound dehiscence is expected to be higher. Milk fistula is a rare event that may complicate surgery or needle biopsy of the breast in a breastfeeding woman, or in late stages of pregnancy . Suppression of lactation has been proposed in the literature as both a preventive and a therapeutic step. However, the advantages of nursing for both mother and child are numerous, and the author do not propose it as a preventive measure nor as a must in treatment of milk fistula. Prevention and management of milk fistula are discussed in this chapter.

A Systematic Review of Milk Fistula in Nursing Mothers: Modifying the Perspective Toward Maintenance of Breastfeeding

Introduction

Milk fistula is rare, and cessation of nursing has been recommended for treatment. We performed a comprehensive review of all existing literature to explore the causes of milk fistulae and the necessity of discontinuing breastfeeding, and mention our recommendations given our present practice.

Method

Google Scholar, Pubmed, Ovid Medline, and Scopus were thoroughly investigated by using relevant keywords. After screening by reading titles, abstracts, and full texts of returned studies, pertinent articles were included and data extracted.

Results

Seventeen studies including 27 cases were included. Lactation ceased in 16 patients, but this was generally done without awaiting results of conservative management.

Conclusion

We recommend measures for preventing milk fistulae, conservative measures for treatment, and continuation of breastfeeding throughout the process until healing occurs.

Negative-Pressure Suction Cannula for Treatment of Lactational Residual Milk Cavity: A Case Series Study

Background: Several Chinese mothers experience problems related to their breasts during breastfeeding and are referred to hospitals for treatment after a massage by a "cuirushi." Some of these patients develop large breast abscesses. Notably, the treatment of residual milk cavities is difficult after pus aspiration. Lactational residual milk cavities in the breast hinder effortless breastfeeding, but no solution has been reported thus far. This study aims to explore the use of a simple and minimally invasive method for treating lactational residual milk cavities and enabling mothers to breastfeed effortlessly. Materials and Methods: We retrospectively analyzed clinical data of 28 patients with lactational residual milk cavities treated using negative-pressure suction cannula and drainage at our department from December 2016 to May 2019. The success rate, safety, and feasibility of this technique are summarized. Results: Among the 28 patients, the first catheterization was successful in 7 (25%) patients, the second in 13 (46.4%) patients, and the third or subsequent catheterizations in 8 (28.6%) patients. The intubation time was <10 days in 3 patients, between 10 and 20 days in 12 patients, and >20 days in 13 patients. During and after treatment, 21 patients (75%) continued breastfeeding with the affected breast. Conclusions: Ultrasound-guided negative-pressure suction cannula is a new method to treat lactational residual milk cavities that may remain after initial therapy for lactational breast abscess. The treatment of lactational residual milk cavities offers significant advantages in supporting mothers during breastfeeding.

Surgical drainage of lactational breast abscess with ultrasound-guided Encor vacuum-assisted breast biopsy system

Lactational breast abscess is a serious complication of mastitis and commonly diagnosed in breast-feeding women. The traditional drainage of breast abscess was often performed with incisive technique which may result in prolonged healing time, regular dressings, dressing pain, interfering with breastfeeding and unsatisfactory cosmetic outcome. As minimal invasive alternatives to incisive drainage, needle aspiration or percutaneous catheter placement cannot completely replace incisive drainage for the inability to treat large, multiloculated or chronic abscess. Vacuum-assisted breast biopsy system (VABB) has been successfully applied in the treatment of benign breast diseases with satisfactory cosmetic outcomes. Among VABB devices, EnCor system has some distinctive features that make it an appropriate candidate for the treatment of lactational breast abscesses. In this study, for the first time, we investigated the feasibility, efficacy, and cosmetic results of surgical drainage of lactational breast abscess with US-guided Encor VABB system. Our data suggests this procedure could serve as a promising alternative for women with lactational breast abscess who require incisive intervention with high cure rate, relatively short healing time, low recurrence rate, few complications, satisfactory cosmetics outcome and without interfering with breastfeeding.