Retrospective Review of Breast abscess cases in a tertiary hospital in Addis Ababa, Ethiopia, 2020

Abstract

Abstract Background: Breast abscess is a localized collection of pus within the breast.Breast abscess can be classified into Lactational (LBA) or puerperal and non-lactational breast abscess (NLBA). Lactational breast abscess occurs as a complication of lactational mastitis. Non-lactational breast abscess are categorized according to the location into central (sub-areolar) and peripheral. Underlying structural disease like peridcuctal mastitis is the major predisposing condition for patients with NLBA. The most common pathogen identified is S. aureus in LBA although streptococcus and anaerobic flora can also be identified in NLBA. Treatment of breast abscess entails drainage of the abscess either surgically or with aspiration. Objective: To Assess the pattern of breast abscess in St. Paul Hospital Millennium Medical College. Methodology: Cross-sectional study design from September 1 2015- August 31, 2020. All patients treated for Breast abscess in the study period were included in the study. Data was scollected using a questionnaire by trained medical doctors. Data was entered into SPSS. Data was categorized and presented in Means and Median. Result: Lactational breast asbcess is more common than Non-lactational breast asbcess (87.1% Vs 12.9%). Left side occurred in 47.4% while right side occurred in 45.0% and bilateral breast abscess occurred in 7.7% of patients. Most common site of breast abscess was lower outer quadrant accounting for 25.4%. Patients presented at a median duration of 11 days (2-150 days). The children who were breastfeeding were mostly above 2 months of age. 14.4% of patients presented with a ruptured abscess. Comorbidites identified include Diabetes Mellitus in 11.5%, Hypertension in 3.3%, HIV in 2.4% of patients. Diabetes Mellitus was most common comorbidity in NLBA patients. All patients were treated with Incision and Drainage and a median abscess size of 60 ml was drained. The most common type of incision done was periareolar accounting for 29.7%. All patients received antibiotics postoperatively. The most commonly prescribed medication was Cloxacillin accounting for 80.3% while the next most common was augmentin accounting for 19.7% of patients. The most common biopsy finding was abscess in 60.9% of patients for whom it was sent. 97.1% of patients had follow up. 5.8% of patients developed recurrence of their abscess at a median duration of 1 month. Conclusions: Lactational breast abscess is more common than non-lactational breast abscess. Lactational breast abscess was found more commonly in primiparous women. Documentation of Non-lactational breast abscess as central or peripheral should be done as it has implications in management. Diabetes Mellitus is the most common comorbidity in non-lactational breast abscess and even minor injuries should be cared for appropriately and health seeking behavior should be improved. Treatment with ultrasound guided aspiration should be tried for able and willing patients. Anaerobic coverage should be given for patients with non-lactational breast abscess. Sending specimen for culture and sensitivity should be made a regular practice for tailoring treatment.