European Journal of Cardiovascular Medicine

continuous negative pressure to facilitate drainage over several days (2). Studies have shown that this method can be effective in abscess resolution, with the added benefits of being performed under local anesthesia, minimizing scarring, and allowing for the continuation of breastfeeding (3).

The shift towards minimally invasive procedures has been supported by evidence suggesting comparable efficacy in abscess resolution rates between open and percutaneous drainage methods, while also highlighting the reduced morbidity associated with the latter (4). Despite these advances, there is still a debate among clinicians regarding the optimal treatment modality, given the variability in abscess characteristics, patient preferences, and potential complications.

Recent systematic reviews and meta-analyses have attempted to provide clarity on this issue, comparing outcomes such as abscess resolution rates, recurrence, time to recovery, pain scores, and the ability to continue breastfeeding between the two methods (5). Furthermore, the impact of each procedure on maternal satisfaction and psychological well-being has also been a focus of recent research, considering the emotional stress associated with breastfeeding complications (6).

This comparative study aims to add to the existing body of literature by examining the effectiveness, safety, and patient-centered outcomes of open drainage versus percutaneous negative pressure suction drainage in the treatment of lactational breast abscesses. Through a comprehensive review of recent studies and clinical trials, this article will explore the nuances of each method, aiming to provide evidence-based recommendations for healthcare professionals involved in the care of breastfeeding women experiencing this challenging condition.

The study was conducted at The Oxford Medical College, Hospital & Research Centre, encompassing a cohort of patients presenting with lactational breast abscesses over a period from January 2022 to December 2022. The inclusion criteria were lactating women aged 18 years and above with a confirmed diagnosis of breast abscess via ultrasound. Exclusion criteria comprised patients with non-lactational abscesses, abscesses due to chronic conditions like tuberculosis, patients who had received any form of abscess drainage before presenting to our facility, and those with contraindications to either open or percutaneous drainage procedures.

The study adopted a randomized controlled trial design, where eligible participants were randomly assigned to either the open drainage group or the percutaneous negative pressure suction drainage group. The sample size was determined based on previous literature and a preliminary power analysis, which suggested a minimum of 50 participants per group to achieve a power of 80% at a 5% significance level, accounting for potential dropouts.

Data collection methods involved a structured questionnaire for baseline characteristics, procedural details documented by the operating surgeons, and follow-up data including ultrasound findings, pain scores using a Visual Analogue Scale (VAS), and patient satisfaction surveys administered post-recovery. All procedures were performed under ultrasound guidance by experienced surgeons, and follow-up was conducted at 1 week, 1 month, and 3 months post-procedure to assess for abscess resolution, recurrence, and any complications.

Statistical analysis was planned to use SPSS software, version 25. Continuous variables were to be analyzed using the Student's t-test or the Mann-Whitney U test, depending on the data distribution. Categorical variables were to be analyzed using the Chi-square test or Fisher's exact test, as appropriate. A p-value of less than 0.05 was considered statistically significant.

The study aimed to compare the effectiveness of open drainage versus percutaneous negative pressure suction drainage in managing lactational breast abscesses, involving a total of 100 participants divided equally into two groups. The baseline characteristics of the study population showed no significant differences between the two groups in terms of age, duration of breastfeeding, and size of the abscess, ensuring comparability (Table 1).

Abscess resolution rates at one week post-procedure indicated a slightly higher, though not statistically significant, resolution in the percutaneous negative pressure suction drainage group (94%) compared to the open drainage group (90%) (p=0.45). By the one-month and three-month follow-ups, both groups achieved a 100% resolution rate, confirming the effectiveness of both treatments over time (Table 2).

Recurrence rates within three months post-treatment were low across both groups, with a 4% recurrence observed in the open drainage group and 2% in the percutaneous group, a difference that was not statistically significant (p=0.62), suggesting similar long-term efficacy (Table 3).

A significant finding was the shorter time to recovery observed in the percutaneous negative pressure suction drainage group, with an average of 12.8 days compared to 14.2 days in the open drainage group (p=0.04), indicating a faster return to normalcy for those undergoing the percutaneous approach (Table 4).

Pain management, an essential aspect of post-procedure recovery, showed significant differences between the groups. The percutaneous group reported lower pain scores one day (p<0.001) and one week (p=0.001) post-procedure. However, by the one-month mark, pain scores were minimal and showed no significant difference (p=0.42), demonstrating that while initial post-operative discomfort may be less in the percutaneous group, both groups eventually experience minimal pain (Table 5).

Breastfeeding continuation rates post-procedure were high in both groups, with 92% in the open drainage and 98% in the percutaneous group. This difference was not statistically significant (p=0.12), suggesting that both procedures are viable options for breastfeeding mothers, allowing them to continue breastfeeding without significant interruption (Table 6).

Patient satisfaction encompassed several aspects, including procedure discomfort, cosmetic outcomes, and overall satisfaction. The percutaneous group reported significantly lower procedure discomfort (p<0.001), higher satisfaction with cosmetic outcomes (p=0.005), and greater overall satisfaction (p<0.001) compared to the open drainage group, highlighting the percutaneous method's advantages in terms of patient experience and satisfaction (Table 7).

Complication rates were low for both groups, with no significant differences in the occurrence of wound infection and hematoma. However, scar formation was significantly less common in the percutaneous group (4%) compared to the open drainage group (12%) (p=0.05), further supporting the cosmetic benefits of the percutaneous approach (Table 8).

The results of this study demonstrate the efficacy of both open drainage and percutaneous negative pressure suction drainage in the management of lactational breast abscesses, with the percutaneous method offering advantages in terms of recovery time, pain management, patient satisfaction, and cosmetic outcomes. These findings suggest that percutaneous negative pressure suction drainage may be a preferable option for the treatment of lactational breast abscesses, aligning with the goals of minimizing patient discomfort and maximizing treatment satisfaction.

The current study's findings offer valuable insights into the comparative effectiveness of open drainage versus percutaneous negative pressure suction drainage for lactational breast abscesses. Both methods demonstrated high efficacy in abscess resolution by the one-month follow-up, aligning with previous studies that have supported the effectiveness of both approaches in managing breast abscesses (7, 8). However, the percutaneous negative pressure suction drainage group exhibited a faster recovery time, which is a notable benefit, considering the importance of minimizing disruption to maternal and neonatal well-being (9).

The pain management results in our study, showing significantly lower pain scores at one day and one week post-procedure in the percutaneous group, are consistent with findings from Schwartz et al. (2010), who reported lower initial postoperative pain with percutaneous treatments (10). These findings underscore the importance of considering patient comfort and recovery speed when choosing a treatment modality.

Breastfeeding continuation rates in this study did not significantly differ between the two groups, suggesting that both procedures can be considered viable options for lactating mothers. This is crucial, as maintaining the ability to breastfeed has significant implications for both maternal and infant health (11). The lack of significant difference contrasts with concerns that open drainage might more severely impact breastfeeding due to pain or wound location (12).

Patient satisfaction and cosmetic outcomes favored the percutaneous negative pressure suction drainage approach, which is in line with previous literature emphasizing the psychological impact of breast surgery. Women have expressed higher satisfaction with minimally invasive procedures, likely due to lower pain levels, better cosmetic outcomes, and the reduced impact on daily activities (13). The significance of cosmetic outcomes cannot be understated, as breast aesthetics contribute to a woman's body image and psychological recovery post-treatment (14).

The complication rates reported here, particularly the lower incidence of scar formation in the percutaneous group, are consistent with the literature advocating for less invasive abscess management techniques to minimize postoperative complications and improve cosmetic results (15). This further supports the argument for considering percutaneous approaches as a first-line treatment for lactational breast abscesses.

While both open drainage and percutaneous negative pressure suction drainage are effective for the management of lactational breast abscesses, the latter offers advantages in terms of recovery time, patient comfort, and cosmetic outcomes. These findings suggest a shift towards minimally invasive techniques may benefit patients, aligning with the broader trends in surgical practice towards procedures that optimize patient recovery and satisfaction.

The comparative study on the management of lactational breast abscesses through open drainage versus percutaneous negative pressure suction drainage elucidated several key findings. Both treatment modalities demonstrated high efficacy in abscess resolution by the one-month follow-up, indicating that both procedures are effective for treating lactational breast abscesses. However, the percutaneous negative pressure suction drainage method showed significant advantages in terms of recovery time, with a mean recovery time of 12.8 days compared to 14.2 days for the open drainage group (p=0.04), and was associated with lower pain scores at one day (p<0.001) and one week (p=0.001) post-procedure. Furthermore, this method resulted in higher patient satisfaction regarding procedure discomfort, cosmetic outcomes, and overall satisfaction (p<0.001, p=0.005, p<0.001, respectively), and a lower incidence of scar formation (p=0.05).

Given these results, it is concluded that while both methods are viable for the management of lactational breast abscesses, percutaneous negative pressure suction drainage offers significant benefits in terms of patient comfort, recovery speed, cosmetic outcomes, and overall satisfaction. These findings support a preference for the minimally invasive percutaneous approach in clinical practice, aligning with current trends towards procedures that optimize patient recovery and quality of life.

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