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Characterization of Pediatric Breast Abscesses and Optimal Treatment: A Retrospective Analysis
Charlene Dekonenko1, Neal Shah2, Wendy Jo Svetanoff1
1Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri.
Insights
Pediatric breast abscess treatment outcomes were studied. Antibiotics alone, aspiration, or incision and drainage (I&D) showed similar success rates, suggesting antibiotics alone may be a safe initial approach for pediatric breast abscesses.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Breast Health
Background:
- Limited literature exists on pediatric breast abscesses, often relying on adult treatment guidelines.
- Pediatric patients may have unique risk factors and considerations, such as developing breast buds, influencing treatment choices.
Purpose of the Study:
- To characterize pediatric breast abscesses and compare treatment outcomes.
- To evaluate the effectiveness of different treatment modalities including antibiotics alone, needle aspiration, and incision and drainage (I&D).
Main Methods:
- Retrospective review of 96 pediatric patients with primary breast abscesses (2008-2018).
- Analysis of antibiotic use, treatment required, and risk factors for abscess and recurrence.
- Comparison of treatment success rates and assessment of long-term outcomes like scarring and deformity.
Main Results:
- Antibiotics alone were the most common initial treatment (47%), followed by I&D (27%) and aspiration (26%).
- Treatment success rates were comparable across modalities: 80% for antibiotics alone, 90% for aspiration, and 96% for I&D.
- Persistent disease occurred in 13% of patients, with no significant difference based on initial treatment modality.
Conclusions:
- Treatment modality was not associated with persistent disease in pediatric breast abscesses.
- A trial of antibiotics alone can be considered to minimize risks of breast bud damage and cosmetic issues associated with invasive procedures.
Background:
Literature on pediatric breast abscesses is sparse; therefore, treatment is based on adult literature which has shifted from incision and drainage (I&D) to needle aspiration. However, children may require different treatment due to different risk factors and the presence of a developing breast bud. We sought to characterize pediatric breast abscesses and compare outcomes.
Materials And Methods:
A retrospective review of patients presenting with a primary breast abscess from January 2008 to December 2018 was conducted. Primary outcome was persistent disease. Antibiotic utilization, treatment required, and risk factors for abscess and recurrence were also assessed. A follow-up survey regarding scarring, deformity, and further procedures was administered. Fisher's exact and Kruskal-Wallis tests for group comparisons and multivariable regression to determine associations with recurrence were performed.
Results:
Ninety-six patients were included. The median age was 12.8 y [IQR 4.9, 14.3], 81% were women, and 51% were African-American. Most commonly, patients were treated with antibiotics alone (47%), followed by I&D (27%), and aspiration (26%). Twelve patients (13%) had persistent disease. There was no difference in demographic or clinical characteristics between those with persistent disease and those who responded to initial treatment. The success rates of primary treatment were 80% with antibiotics alone, 90% with aspiration, and 96% with I&D (P = 0.35). The median time to follow-up survey was 6.5 y [IQR 4.4, 8.5]. Four patients who underwent I&D initially reported significant scarring.
Conclusions:
Treatment modality was not associated with persistent disease. A trial of antibiotics alone may be considered to minimize the risk of breast bud damage and adverse cosmetic outcomes with invasive intervention.
