Management of lactational and non-lactational breast abscesses: an evidence-based framework to support breast surgeon decision-making.

Breast abscesses are common benign surgical conditions, particularly among lactating women but they are increasingly recognized in non-lactational settings. Despite their clinical and psychosocial impact, management remains heterogeneous and lacks widely accepted guidelines. A structured narrative review (2012-2024) was conducted using PubMed, Scopus and Web of Science. Evidence from randomized trials, observational studies and systematic reviews was combined with the clinical experience of a high-volume tertiary Breast Unit to develop a multidisciplinary, ultrasound-based management algorithm. Across seven studies (including randomized trials, comparative studies, and a meta-analysis), US-NA demonstrated high resolution rates (85-92%) with shorter healing times and improved patient-reported outcomes compared with I&D. Surgical drainage remains the preferred treatment for collections > 5 cm, multiloculated or recurrent abscesses, particularly in non-lactational cases. Breast surgeons play a pivotal role in diagnosis, intervention selection and coordination of multidisciplinary care. The proposed algorithm provides a reproducible, evidence-based tool to standardize management. Multicenter, surgeon-led studies are needed to support international guideline development.