A 26-year-old lactating mother presents with a painful, fluctuant 4 cm swelling in the right breast with overlying erythema, unresponsive to 48 hours of oral antibiotics. Ultrasound confirms a collection with liquefaction. What is the most appropriate next step in management?
- A Ultrasound-guided needle aspiration with continued antibiotics ✓
- B Stop breastfeeding from both breasts immediately
- C Start broad-spectrum antifungal therapy
- D Immediate modified radical drainage with wide excision of the sinus tract
Correct answer: A. Ultrasound-guided needle aspiration with continued antibiotics
Explanation
B lactational abscess with liquefied pus is managed by ultrasound-guided aspiration combined with antibiotics, repeated as needed, with incision and drainage reserved for failures or multiloculated collections. Breastfeeding should be continued from the affected breast if possible because emptying aids resolution; stopping feeds worsens engorgement. Wide excision has no role and risks fistula formation. Flucloxacillin covering Staphylococcus aureus remains the antibiotic backbone.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.