Background: Management of breast abscess involves incision and drainage; however, this invasive approach is associated with a high rate of complications. Ultrasound guided aspiration has emerged as an alternative to surgical drainage due to its ability to recognize a multiloculated abscess, assess the adequacy of drainage and the possibility of ruling out simple mastitis. We aim to compare between the incision and drainage and ultrasound-guided aspiration for the treatment of breast abscesses. Patients and Methods: forty –eight patients attended private hospital in Jeddah during a period from April 2011 to August 2015, were divided into two groups: Group (1) (US-guided needle aspiration) and group (2) (incision and drainage), each group was 24 patients .Incision and drainage was done under general anesthesia, whereas US-guided aspiration was done under local anesthesia with antibiotic coverage after the pus sample was taken for culture and sensitivity. Failure rate of procedure, a rate of healing and complications were recorded, follow-up of patients done for 6 weeks. Results: Group (1) show failure rate was 3/24(12.50%) and these patients underwent surgical operation, low incidence of milk fistulae 1 patient (4.16%), and better cosmetic appearance. While group (2) shows failure rate was 1 patient (4.16%) who underwent excision as chronic abscess, 4/24 patients (16.66%) show milk fistulae which necessitate cessation of breast feeding and unpleasant cosmetic appearance. Conclusion: Ultrasound-guided aspiration of breast abscesses is a better modality of treatment of breast abscess than incision and drainage. Key words: Breast, abscess ultrasonography; US-guidance, incision, and drainage.