Title: ‘I don't want to be a guinea pig’ - Swedish women’s experiences of breast abscess
treatment
Version: 2 Date: 23 Oct 2023
Reviewer:  Dana Marie Scott
Reviewer's report:
Thank you for submitting your paper “‘She did not like to be a guinea pig’ - Swedish women’s
experiences of breast abscess treatment” for review. I recommend this paper for publication.
I think this paper is an important contribution to the available literature, as there is little
qualitative information available about the experience of patients being treated for breast
abscess. Additionally, as pointed out in the paper and as I have experienced in my own clinical
practice, breastfeeding medicine is an underemphasized but vital area of medicine that often
falls between specialties. As women are encouraged to breastfeed exclusively in accordance
with recommendations from numerous professional organizations, including the World Health
Organization, it is critical that health care providers be more adept at treating breast feeding
issues (including breast abscess) in a way that honors this unique point in an individual’s life.
I have the following constructive feedback points for the authors:
• Table 1: I like the brief description about the different treatment options. For antibiotics I
would recommend stating that antibiotics alone are typically not used for the treatment of breast
abscess. The antibiotics referred to are in addition to drainage (either I&D or aspiration). For
needle aspiration, I would clarify that the “although some women may require incision and
drainage” is referring to those women who fail aspiration. I agree that aspiration is preferred for
most abscesses, however typically incision and drainage is typically performed for an abscess
that extends superficially with palpable fluctuance or overlying early skin necrosis.
• In line 83 you state “while it is considered safe to continue breastfeeding”. Continuation is
typically recommended during treatment for mastitis and puerperal abscess, so I would suggest
changing the word “safe” to “recommended”
• In the background section I think it would be helpful to have some information about
breastfeeding in Sweden if available (e.g. overall rates, average length of breastfeeding). You
address some of the support infrastructure unique to Sweden, which is wonderful, but I think
having some of this background information would be very helpful. It might also be helpful to
comment on the typical parental leave available to mothers in Sweden, as the need to return to
work is known to be a barrier to continuation of breast feeding. This information will help your
data be interpreted on a more global scale.
• Line 157: Was there any standardization to the follow up questions asked to study participants?
If so, can you elaborate on those?
• Sampling strategy: I don’t see a discussion of how and why this number of participants was
selected other than it being a convenience sample in the time frame of interest. Did you do
anything to assess sampling saturation? Did you consider expanding your study time frame to
recruit additional participants?
• Table 3: Is there data on when postpartum the breast abscess occurred (e.g. within first 6 weeks,
6 weeks – 6 months, #6 months postpartum)? I think this would be interesting, particularly if
there is any difference in the participants’ experiences based on when they presented.
• Table 4:
o Please clarify what is meant by “pig-tail drainage”. Is this an incision & drainage with a drain
placement? If so, how is it different from the “drainage tube”. A relatively high percentage of
your patients had drains placed, which is different from my clinical practice (drains typically
reserved for complex abscesses or ones that require multiple drainages). Can you comment on
if this is relatively standard practice in your area or is this an indication that a large proportion
of your study population had very severe abscess?
o  Additionally, the line “rupture (one previous breast abscess)” is unclear – was this rupture of
the current or prior abscess? I would consider putting the “prior breast abscess” data in table 3.
• Section “A long, protracted waiting time to undergo drainage of the breast abscess”: Can you
please explain what you mean by “mature”? In my clinical practice, abscesses do not need to
wait until they are close to rupture to be drained. Is this standard practice in Sweden?
Thank you for the opportunity to review your interesting study, and best of luck with the
publication process.