A COMPARATIVE STUDY OF THE OUTCOME OF NEEDLE ASPIRATION VERSUS INCISION AND DRAINAGE IN THE TREATMENT OF LACTATIONAL BREAST ABSCESS

Abstract

Background: Lactational breast abscess is a common complication of puerperal mastitis and remains an important cause of morbidity among breastfeeding women, particularly in low and middle-income countries. Conventional incision and drainage has traditionally been regarded as the standard treatment; however, ultrasound-guided needle aspiration has emerged as a minimally invasive alternative with potential advantages related to recovery, cosmesis, and wound morbidity. Objective:  To compare the clinical outcomes of ultrasound-guided needle aspiration and conventional incision and drainage in the management of lactational breast abscess. Study Design: Randomised controlled trial. Settings: Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan. Duration of Study: March 3, 2025, to June 3, 2025. Methods: A total of 102 lactating women with clinically and ultrasonographically confirmed breast abscesses were enrolled and randomly assigned to incision and drainage (Group A, n = 51) or ultrasound-guided needle aspiration (Group B, n = 51). Cure, defined as complete clinical resolution with ultrasonographic confirmation, was the primary outcome in the aspiration group. Secondary outcomes included procedure duration, need for repeat intervention, post-procedural complications, and conversion to incision and drainage. Statistical analysis was performed using SPSS version 25, with p-values <0.05 considered statistically significant. Results: Baseline demographic and clinical variables were comparable between groups. The mean procedure time was significantly shorter in the needle aspiration group (9.6 ± 3.2 minutes) compared with the incision and drainage group (18.9 ± 4.3 minutes) (p < 0.001). Definitive cure was achieved in 94.1% of patients undergoing incision and drainage and 80.4% of those treated with needle aspiration (p = 0.04). Repeat procedures were required in 56.9% of patients in the needle aspiration group, whereas none were necessary in the incision and drainage group (p < 0.001). Wound infection and delayed wound healing were significantly more frequent following incision and drainage, while residual abscess on follow-up ultrasonography was more common after needle aspiration. Conversion to incision and drainage was required in 13.7% of patients initially managed with needle aspiration. Conclusion: Incision and drainage provide higher definitive cure rates in lactational breast abscesses but are associated with increased wound-related morbidity. Ultrasound-guided needle aspiration offers shorter procedure time and fewer wound complications, but is limited by lower cure rates and a higher rate of repeat interventions. Management should be tailored to the characteristics of the abscess, available resources, and patient preferences.