I appreciated Becky's long, detailed post about the internal distruction
caused by delayed tx of  breast abscess.  The conservative approach is to
perform ultrasound visualization (and perhaps needle biopsy)  on any lump
which fails to resolve by standard tx within a fairly short time. By a short
time, I would say 48 hours. Because if it is a case of mastitis, bed rest,
draining the breast, and initiation of antibiotic tx should demonstrate some
relief of sx almost immed.  BTW,  The surgeon I work with told me that about
25% of the breast abscesses he sees do not immed. present with fever.

 When an abscess forms, the body is walling off an area to try to contain
infection.  However, if it is infected (rather than a cyst filled with
sterile material, ie, a galactocele, which is filled with milk,) the
material inside the walled off area continues to reproduce bacteria and to
grow.  Sooner or later it will burst and do a lot of damage.  If it is close
to the surface, it may burst to the surface, drain there and resolve.  Deep,
internal abscesses really pose more of a problem with sepsis and distruction
of tissue.  Thank you, Becky, for the graphic description of the distruction
to the ductal system.  I hope that is a cautionary image we all retain.

The problem in the early management of a woman who presents with sx which
may be mastitis, or may be abscess,  is that if the abscess walls off,
antibiotic can't reach the infection and do nothing really to help the
woman.  I think that we need much more detailed instruction on the etiology
of abscess, and more specifics on recommendations for all members of the
health care team, including physicians who may not be well trained or
experienced in diseases of the lactating breast.  I wish that some of the
physicians on lactnet who are expert in this area would give us a lesson.
This, to me, is one of those areas when real expertise is important if we
are adequately to protect consumers.  Here is a situation where, in spite of
the best intentions,  appropriate tx was delayed  to the point where the
woman's future lactational capacity has probably been damaged in that
breast.  I compliment Becky on doing so much to advocate for this patient,
and on the open-mindedness of the surgeon, who was so willing to listen.

Barbara



Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html