Breast abscess incision and drainage

Breast abscess, as the name suggests, is an abscess that grows on a woman's breast. The most direct, fastest and most effective way to treat this disease is breast abscess incision and drainage. Although this type of surgery has good results, a lot of things need to be done during the operation. After the operation, careful postoperative care is also required to ensure the safety of the operation and good results. Here I will introduce to you some relevant knowledge about breast abscess incision and drainage!

1. Indications

Breast incision and drainage is suitable for cases where inflammatory masses around the nipple or in the breast tissue begin to soften and show a sense of fluctuation; deep infection that forms an abscess, where pus breaks through the breast fibrous capsule and enters the honeycomb tissue behind the breast, and the pus is suctioned out through ultrasound examination or puncture; and mixed infection of breast tuberculosis.

2. Surgical steps

1. Make more radial incisions extending outward from the nipple. You can also make horizontal incisions with a slight arc depending on the location of the abscess. If the two ends of the incision extend beyond the abscess to the normal breast tissue, it may cause breast fistula. The incision should not be too small. If the incision is bottle-mouth-shaped at the top of the abscess cavity, drainage will be inadequate and healing will be delayed. For abscesses around the nipple or above the breast, an arc-shaped incision can be made at the edge of the areola or in concentric circles. For deep breast abscesses located in the lower quadrant, a thoraco-breast incision along the breast fold can be chosen, which not only ensures smooth drainage but also reduces scar tissue.

2. First puncture the abscess cavity to determine its depth, then make an incision at the top of the abscess cavity, appropriately separate the subcutaneous tissue and insert the vascular clamp directly into the abscess cavity along the direction of the needle. After the pus is discharged, the incision needs to be enlarged.

3. Insert your fingers through the incision to separate the abscess cavity partitions, so that the small partitions are completely penetrated and the separated necrotic tissue is discharged.

4. For superficial abscess, flush the abscess cavity with isotonic saline after drainage and drain with vaseline gauze or rubber sheet. If you use your fingers to explore the bottom of the abscess and find that the abscess cavity is large and the incision is high, you should make another incision at the best position for gravity drainage to facilitate drainage. Place a strip of vaseline gauze or a rubber sheet or a rubber tube, secure it to the skin or use a safety pin to prevent it from slipping into the abscess cavity, loosely pack the area with vaseline gauze, and cover with a gauze bandage.

5. Retrobreast abscess is located between the breast and the pectoralis major muscle fascia and is difficult to drain from the front of the breast. During the operation, the breast is pushed upwards, and an arc-shaped incision is made along the fold where the breast meets the chest wall at the outer or inner lower edge of the breast, depending on the location of the bottom of the abscess. Then, blunt separation was performed with vascular forceps to reach the abscess cavity in the space before the pectoralis major fascia. After draining the pus, insert the finger, separate the fibrous septum of the pus cavity, remove most of the necrotic tissue, and then flush the pus cavity with isotonic saline or 3% hydrogen peroxide solution. Place a drainage rubber sheet (or tube) or vaseline gauze and secure the drainage properly to prevent it from dislocating. Apply gauze bandage.

6. Pus should be cultured for bacteria. For patients with recurrent chronic breast abscesses, the abscess cavity wall should be excised for pathological examination.

3. Postoperative treatment

1. Use a bandage to support the breasts after surgery to prevent sagging, which helps improve local blood circulation.

2. Sucking and breastfeeding should be suspended during the lactation period. Use a breast pump to drain your milk regularly. If there is milk leakage or the patient voluntarily weans, 5 mg of ethidium bromide can be taken orally 3 times a day for 3 to 5 days.

3. Change the dressing every 1 to 2 days after surgery to ensure effective drainage and prevent residual abscesses, prolonged non-healing, or premature closure of the incision.

4. For patients with severe infection and systemic poisoning, the infection should be actively controlled and systemic supportive therapy should be given.