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Should The Entire Painful Cyst In Breast Be Aspirated?

Posted on Wed, 5 Aug 2015

Question: Hi Doctor, My Mother 53 yrs old experienced sudden painful lump in breast one week back.
Sono-Mamography showed complex cyst of BIRAD rating 2 (report attached). Breast surgeon tried to aspirate the cyst in OPD setting. She was able to aspirate very thick pus but there was some solid residue left behind. She was not satisfied and asked us to follow up in 15 days. She prescribed Augmentin Duo 1000 twice a day for 5 days. My question is, What could have caused such thick pus and why was the entire cyst could not be aspirated?. My Mom is nearing Menopause and has no family history of breast cancer. Should we wait for 15 days or consult her before that?

Answered by Dr. Deepti Verma (22 minutes later)

Brief Answer:
Likely breast abscess

Detailed Answer:
Hi XXXXX, I have gone through your question and understand your concerns.I have reviewed the mammograph report and the aspiration notes. The mammograph is suggestive of a localized breast abscess which occurs due to infection. In this condition, there is a cyst formation containing infective and inflammatory substance leading to thick pus formation, which was aspirated.
The entire cyst could not be aspirated likely due to its complex nature and hence it contains loculations and needle is unable to reach all the compartments of the cyst to apirate the pus. A proper and complete antibiotic course is needed to treat the infection completely.
Her prescription paper mentions history of breast cancer in her paternal grandmother. I would suggest her to complete her antibiotic course, and if the lump still remains of same size and there is no relief, then she should consult an oncologist for further evaluation.
Hope you found the answer helpful. Please do get back for further queries.
Wishing you good health.
Regards,
Dr Deepti Verma.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Deepti Verma (19 minutes later)

Thanks Doctor,
I have read that breast abscess could be caused by Inflammatory breast cancer as well which is quite aggressive. Do you think that could be a possibility too?.
Because she has no fever or other symptom related to infection.

Answered by Dr. Deepti Verma (32 minutes later)

Brief Answer:
It can be a possibility

Detailed Answer:
Hi XXXXX, thanks for responding. Yes, it can be a possibility and should be ruled out. However, mammography showed no signs of malignancy as of now.
Still, if you are very apprehensive, then you should clear your doubts by consulting an oncologist and getting your mother examined and further investigated.
Hope you found the answer helpful. Please do get back for further queries.
Regards,
Dr Deepti Verma

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Deepti Verma (13 hours later)

Thanks doctor.
Does the presence of pus in aspiration procedure rule out IBC?
or IBC also presents with pus while aspiration.

Answered by Dr. Deepti Verma (10 hours later)

Brief Answer:
IBC unlikely

Detailed Answer:
Hi XXXXX, inflammatory breast cancer usually do not presents with pus during aspiration. Histopathological examination of pus should be done to rule out any cancerous cells in pus, if present to rule out cancer.
Hope you found the answer helpful. Please do get back for further queries.
Regards,
Dr Deepti Verma

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar