Comparison of Incision and Drainage Against Needle Aspiration for the Treatment of Breast Abscess MUHAMMAD NAEEM, M.B.B.S.,* MUHAMMAD KAZIM RAHIMNAJJAD, M.B.B.S., M.D.,† NASIR ALI RAHIMNAJJAD, M.B.B.S.,* QAZI JALALUDDIN AHMED, M.B.B.S., F.C.P.S.,‡ PYAR ALI FAZEL, M.B.B.S., F.C.P.S.,§ MUHAMMAD OWAIS, M.B.B.S.§ From *Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan; †Liaquat National Hospital, Karachi, Pakistan; the ‡Department of General Surgery, KVSS Hospital, Hamdard University, Karachi, Pakistan; and §Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan We aim to compare the incision and drainage against ultrasound-guided aspiration for the treat- ment of breast abscesses. Sixty-four patients were randomly allocated to Group A (incision and drainage) and Group B (needle aspiration). Incision and drainage was done under general, whereas aspiration was done under local anesthesia with antibiotic coverage after the pus sample was taken for cultures. Time taken to resolve symptoms including point tenderness, erythema and hyperthermia, recurrence of breast abscess, and healing time was recorded. Patients were followed until 8 weeks. Culture and sensitivity of the pus were done. Data were analyzed in SPSS 16.0. The mean difference of healing time was significant (P 5 0.001). A total of 93.3 per cent were healed in Group B and 76.6 per cent in Group A (P 5 0.033). Twenty-two samples (34.37%) had no bacterial yield and the remaining 42 samples (65.6%) yielded 11 anaerobic cultures (17.18%) and 31 aerobic cultures (48.4%). Ultrasound-guided aspiration of breast abscesses with the judicious use of an- tibiotics is a better treatment modality than incision and drainage. B REAST ABSCESS IS the rare complication of mastitis, especially when the treatment is either inadequate or delayed. 1 This condition poses significant stress to women. Whether the abscess is puerperal or non- puerperal, traditional treatment has been incision and drainage, but this results in scars, is expensive, and requires regular postoperative follow-up with cessa- tion of breast feeding. 2, 3 Puerperal breast abscess is a common problem in lactating women, 4 whereas nonpuerperal abscess is a rare entity 5 with significant problems as far as re- currence and microbiological spectrum are concerned. 6 Previous studies have advocated the use of incision and drainage as a primary treatment modality but recent studies have suggested that needle aspiration by ultra- sound or palpatory guidance have been both successful with improved cosmetic and curative outcome. 7–10 This study was aimed to compare the traditional treatment of incision and drainage against percutaneous needle aspiration with ultrasound guidance in the treat- ment of breast abscess. Materials and Methods A total of 110 patients were referred to Department of General Surgery between August 2008 and August 2010 in KVSS Hospital, Karachi, Pakistan, for the treatment of breast lumps. All females underwent ini- tial ultrasound examination within the department by commercially available portable ultrasound machine. The presumptive diagnosis of abscess was made when a homogenous or nonhomogenous hypoechoic shadow was present with some acoustic enhancement. All those females were included with a single abscess smaller than 5 cm in a reproductive-aged group who were not pregnant at the study time and were not being treated for any other breast pathology. Women with sinus/fistula of breast abscess, pro- longed history, and necrosed skin were excluded from study. Sixty-seven patients met the inclusion criteria after detailed history and examination as well as ul- trasound. Three patients refused to take part in the study and the remaining 64 were randomly divided into 32 Address correspondence and reprint requests to Muhammad Naeem, M.B.B.S., B-8, Akbar Apartments, Civil House Road, Karachi, Pakistan 74200. E-mail: dowgrad2012@yahoo.com. 1224