Breastfeeding and breast abscess

July 27, 2011. Posted in: BF Concerns: Mother

by Rhondda Smiley. Reprinted with permission from the author.

I developed a breast abscess after I returned to work full time when my daughter India was 10 months old. I had mastitis my 4th day back, and then a recurrent plug that I just couldn’t get rid of. By my sixth week back, I had a full blown abscess the size of a kiwi. It was horrible – the area was very tender, especially when my breasts were full or if my daughter hit it while nursing, and my entire immune system was very taxed. Almost as horrible was having to deal with medical professionals who were very ill-informed about breastfeeding, telling me to wean.

There is some information on abscesses in Dr. Jack Newman’s book, but I found it very difficult to find anything else about them. I called my La Leche League leaders, and searched the internet, without much luck. Fortunately, they are not too common, but this made for a frustrating situation as I was also dealing with doctors who didn’t know much about breastfeeding. The most effective thing I did was to put out feelers to every single mother, doula, midwife, lactation consultant and LLL leader I knew by email. I was able to speak with three other mothers about their abscess experiences. This was invaluable.

Here is what I learned. Abcesses are rare, occurring in 3-11 percent of women who have infectious mastitis. Abscesses can also develop with a recurrent plug that keeps occurring in the same spot. Abscesses can be diagnosed either by aspiration (lanced and drained with a needle by your doctor) or by ultrasound. If you are having an ultrasound, be sure to empty your breasts as much as possible before the test so that the technicians can more easily read the results. If you have an abscess aspirated, ask your doctor to culture the fluid that is drawn out so that an appropriate antibiotic can be prescribed.

Abscesses can sometimes be resolved just by being aspirated, but must sometimes be surgically drained (called an incision and drainage, or I&D). An I&D can be done either under a local or a general anesthetic. It is important to request that any incision be made radially (from the chest in towards the nipple) instead of around the areola. Many breast surgeries are done around the areola for aesthetic reasons, but this cuts more milk ducts and may affect milk supply. After an I&D, the incision is left open and packed with a dressing so that it can continue to drain and heal from the outside in.

It is important to either nurse or pump the affected breast while the incision is healing to prevent engorgement, relieve pressure on the incision and help to prevent the recurrence of mastitis. As with any plug or mastitis, weaning “cold turkey” will likely complicate the problem. Some mothers are told that milk from cut ducts will leak from the incision and that they should wean immediately to prevent this. Yes, there can be some leaking at the incision (I didn’t have any), but it shouldn’t be a problem, in part because of the antibodies in the breastmilk. As long as the site of the abscess does not prevent it (i.e. if it’s very close to the areola or nipple), a mother should continue to nurse on the affected breast. If the location of the abscess prevents direct breastfeeding, then it is recommended that you express milk from the affected breast while the incision is healing to prevent complications (even if you intend to wean from that breast after the incision is healed). It is possible to obtain a custom-cut pump flange to facilitate pumping when the incision is very close to the nipple. I have met one mother who had an abscess very close to her nipple. She was unable to nurse on that side, and let her milk dry up on the affected side, but she continued to nurse only on the other side for many months.

Of the three mothers I spoke to before my surgery, their experiences varied wildly. One mother was able to resolve the abscess by having it lanced in her doctor’s office. Another mother had an incision and drainage under general anesthetic with one night in the hospital. Another had an I&D under general anesthetic and had a 5 day hospital stay while being treated with morphine. (She said that her abscess had developed after a botched breast reduction.) So the condition and treatment of abscesses is obviously very individual.

I had my abscess aspirated, but it just filled up again (not uncommon), so then had an I&D under a local anesthetic. The I&D was painful, but I had already spent over 2 weeks trying to get in with a breastfeeding friendly surgeon. I ended up with the director of the local breast clinic instead, who was less than supportive or knowledgeable about breastfeeding. But I didn’t want to have an I&D done at the ER by a general surgeon, who was even less likely to be informed about lactating breasts. If I wanted a general anesthetic, the wait would have been even longer.

I became angry many times due to the ignorant comments and actions of medical professionals that I encountered, especially those who were supposed to be breast “experts,” but seemed to know nothing about lactating breasts or breastfeeding. A radiologist who saw me at the ultrasound clinic asked if my 11 month old daughter was eating solids yet. When I said yes, she asked “so breastfeeding is just a pastime then?” This was at a clinic that dealt exclusively with screening breasts.

In my initial consultation with the director of our local breast clinic, he basically told me that I should be satisfied to stop nursing at 11 months and that as my daughter was now on solids, that she really had no further need for breastmilk. When I went in for my I&D, he informed me once I was lying on the table that he wanted to give me Demerol. I said I did not know if it was safe while I was nursing (I had previously checked out local anesthetics with Motherisk for a dental procedure and knew they were OK) and could we call Motherisk? (This is a service at the Hospital for Sick Children here in Toronto that advises on the safety of various substances for pregnant and nursing mothers. Call them at 416-813-6780.) He asked when I would be nursing again (basically as soon as I got home) and said that it would wear off in 4-6 hours. He brushed off my request to call Motherisk. He offered to have it checked with the hospital pharmacist, but I did not trust this option, knowing that many pharmacists do not access accurate information regarding the safety of drugs for nursing mothers and babies. I decided to call Motherisk myself as soon as we were finished. (I did and found it was safe.) It only occurred to me later that while the drug may have worn off in 4-6 hours, it could have potentially had negative side effects for my baby for much longer. Fortunately, this was not the case.

While I had made not one but two calls before the surgery to inquire about recovery, the surgeon told me while I was lying on the table that I would require a nurse to come in for 2-3 weeks to change my dressing. Since I had just returned to work full time, this new information added unnecessary stress I did not need during a medical procedure. Through my Demerol haze, I had to remind the surgeon and nurse not to cover my nipple with the bandage after the procedure. He told me that it would probably be too painful for me to nurse (he was talking to the WRONG MOTHER!), forgetting that I’d already BEEN nursing with an abscess the size of an orange in my breast for the last two weeks.

I was able to nurse right before and just a few hours after the surgery. I waited at the hospital for about 3 hours before I went home to nurse my baby. I tried pumping the affected breast when I got home, but it was actually easier for me to nurse because of where my incision was – sort of on the inside/underside of my breast. The pump actually covered the incision and this was uncomfortable. I just covered the site with my hand when I nursed so that India wouldn’t accidentally hit it. She didn’t rest on the incision, nor did she have any interest in the dressing. It took my incision about 2-3 weeks to close up. A nurse came into my home each day to change my dressing and check on how the incision was healing. She would rinse the incision with sterile saline, then pack the incision with a packing tape. I started to feel better immediately after the surgery since my body was no longer battling the infection inside me. Also, having that pressure off made nursing more comfortable too. I had absolutely no problems with supply after my surgery, and the incision was very small. My scar is about an inch long.

Ironically, by the time I was dealing with the abscess, my daughter was deciding that she didn’t want a bottle of expressed milk while I was gone. I didn’t really need to pump any milk for her, but kept doing so until I was fully confident that my abscess was completely healed, so that I didn’t run into any problems with plugs or mastitis when I weaned off pumping. I no longer pump, but my daughter continues to nurse into her now third year.

A mother suffering from an abscess needs to get some rest and let herself heal. That is the “message” of mastitis and abscesses to every mother. She needs to rally her troops and get the same kind of support that she hopefully had in the first few days or weeks after birth – her partner to pick up the slack, maybe a mum or mother-in-law to come and spend some time, friends to make meals and help around the house or with older siblings – you know, all that good stuff that seems to dry up after the first month! She needs to do nothing but crawl into bed with baby tucked next to her, rest and feed her baby. Nothing else is more important.

Rhondda Smiley is a mother who also works full time outside the home in arts and entertainment ticketing. She is actively involved in her local La Leche League group. She lives in Toronto with her husband Alan, daughter India and two cats.

Copyright © 2002 by Rhondda Smiley. No portion of this text may be copied or reproduced in any manner, electronically or otherwise, without the express written permission of the author.

More information compiled by kellymom.com

Mastitis and Plugged Ducts @ kellymom

Is This Safe When Breastfeeding? @ kellymom includes information on medications, ultrasound and other medical procedures, local & general anesthesia, and surgery for breastfeeding mothers.

Clinical Protocol Number 4 – Mastitis from the Academy of Breastfeeding Medicine. Includes information on abscess treatment.

Breast Abscess Diagnosis & Management (this is a large– 5.5MB document– abscess information starts on p. S-113). In: World Health Organization. Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors. Geneva: World Health Organization, 2003.

Breast Abscess from AskDrSears.com

Breast Infections and Plugged Ducts by Anne Smith, IBCLC (information on breast abscess is toward the bottom of the page)

Severe breast pain: Chronic mastitis? Q&A by Debbi Donovan, IBCLC

References of interest (most recent listed first)

Kvist LJ, Rydhstroem H. Factors related to breast abscess after delivery: a population-based study. BJOG. 2005 Aug;112(8):1070-4.

Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005, p. 569.

Christensen AF, Al-Suliman N, Nielsen KR, Vejborg I, Severinsen N, et al. Ultrasound-guided drainage of breast abscesses: results in 151 patients. Br J Radiol. 2005 Mar;78(927):186-8.

Riordan J. Breastfeeding and Human Lactation, 3rd ed. Boston and London: Jones and Bartlett, 2004, p.254.

Amir LH, Forster D, McLachlan H, Lumley J. Incidence of breast abscess in lactating women: report from an Australian cohort. BJOG. 2004 Dec;111(12):1378-81.

Rageth CJ, Ricklin ES, Scholl B, Saurenmann E. Conservative treatment of puerperal breast abscesses with repeated sonographically guided aspirations and oral antibiotic administrations. Z Geburtshilfe Neonatol. 2004 Oct;208(5):170-3. [Article in German]

Ulitzsch D, Nyman MK, Carlson RA. Breast abscess in lactating women: US-guided treatment. Radiology. 2004 Sep;232(3):904-9. Epub 2004 Jul 29.

Thirumalaikumar S, Kommu S. Best evidence topic reports. Aspiration of breast abscesses. Emerg Med J. 2004 May;21(3):333-4.

Berna-Serna JD, Madrigal M, Berna-Serna JD. Percutaneous management of breast abscesses. An experience of 39 cases. Ultrasound Med Biol. 2004 Jan;30(1):1-6.

Mohrbacher N, Stock J. The Breastfeeding Answer Book, Third Revised Edition. Schaumburg, Illinois: La Leche League International, 2003, p. 506-507.

Strauss A, Middendorf K, Muller-Egloff S, Heer IM, Untch M, Bauerfeind I. Sonographically guided percutaneous needle aspiration of breast abscesses – a minimal-invasive alternative to surgical incision. Ultraschall Med. 2003 Dec;24(6):393-8. [Article in German]

Dener C, Inan A. Breast abscesses in lactating women. World J Surg. 2003 Feb;27(2):130-3.

Wilson-Clay B, Hoover K. The Breastfeeding Atlas, 2nd ed. Austin: LactNews Press, 2002, p. 85-87.

Marchant DJ. Inflammation of the breast. Obstet Gynecol Clin North Am. 2002 Mar;29(1):89-102.

Love SM. Dr. Susan Love’s breast book, 3rd ed. Cambridge, MA: Perseus Publishing, 2000:95-100.

Hook GW, Ikeda DM. Treatment of breast abscesses with US-guided percutaneous needle drainage without indwelling catheter placement. Radiology. 1999 Nov;213(2):579-82.

O’Hara RJ, Dexter SP, Fox JN. Conservative management of infective mastitis and breast abscesses after ultrasonographic assessment. Br J Surg. 1996 Oct;83(10):1413-4.

Efem SE. Breast abscesses in Nigeria: lactational versus non-lactational. J R Coll Surg Edinb. 1995 Feb;40(1):25-7.

Karstrup S, et al. Acute puerperal breast abscesses: US-guided drainage. Radiology. 1993 Sep;188(3):807-9.

Hayes R, Michell M, Nunnerley HB. Acute inflammation of the breast–the role of breast ultrasound in diagnosis and management. Clin Radiol. 1991 Oct;44(4):253-6.

Karstrup S, Nolsoe C, Brabrand K, Nielsen KR. Ultrasonically guided percutaneous drainage of breast abscesses. Acta Radiol. 1990 Mar;31(2):157-9.

Olsen CG, Gordon RE Jr. Breast disorders in nursing mothers. Am Fam Physician. 1990 May;41(5):1509-16.

Dixon JM. Repeated aspiration of breast abscesses in lactating women. BMJ. 1988 Dec 10;297(6662):1517-8.