Acute Issues of Lactation Mastitis Therapy

Introduction. Lactation mastitis can complicate the course of the postpartum period in every tenth case. Under lactation abscess, the tactic of performing wide incisions to drain the breast abscess and complete lactation by medications is common. International studies report that the treatment of lactational purulent mastitis complicated by an abscess is possible in a minimally invasive way - by puncture or drainage of an abscess under ultrasound navigation. The current trend in the treatment of lactational breast abscess also includes preservation of breastfeeding.
The aim of the study was to develop a modern approach to the complex treatment of purulent lactation mastitis.
Materials and methods. We treated 64 breast abscesses that were complications of lactation mastitis with minimally invasive methods in 2018-2020. Most of the patients preserved lactation.
Results and discussion. The average age of patients was 24.9 years. In the first group of patients (puncture techniques for treating abscesses), the diameter was 24 mm on average, in the second group (drainage technique for treating abscesses) the diameter was 53 mm on average. All procedures were performed under local anesthesia. The average score of the severity of pain syndrome was 4.4 points on the day of surgery. The average duration of drainage was 4.4 days. None of patients had a relapse of the disease or formation of a chronic fistula within 2 months followed by the operation. No negative evaluation of satisfaction with the cosmetic result was received. Breastfeeding continued in 78-87.5% of patients after surgery.
Conclusion. Minimally invasive surgical techniques in the treatment of breast abscesses (punctures and drainage under ultrasound navigation) are the operations of choice. The optimal treatment of lactation mastitis complicated by a breast abscess, in addition to surgical treatment, includes effective expression of breast milk, administration of antibacterial drugs, non-steroidal anti-inflammatory drugs, and preservation of breastfeeding.