Becky, thank you for your very long, informative post on your breast abscess
case.  There is so little in the literature on this subject, and it is such
a distressing situation, that I really appreciate the time you took to give
us an excellent description of what happened, and when, and particularly of
what you noted during the surgery.

I suppose I have worked with about ten moms who were eventually diagnosed
with abscess.  What was interesting for me was how long it took in the case
you describe for the diagnosis of an abscess to be made and for a decision
to be made to drain it - 27 days from the time when the mom first felt the
"cold" symptoms to the time that the surgeon decided it *was* an abscess.
You also mention "hindsight" - I find too that *in retrospect* an abscess
just progresses and you can "see" what was happening, but at the time it all
seems very unclear and everyone keeps hoping that this is "just" mastitis.
In the cases I have worked with it seems to take about three weeks - in the
end it is *such* a relief when someone FINALLY decides to *do* something
about it.  Furthermore there is not always fever or severe pain, at least in
the beginning, and this can confuse everyone.

Your case follows my observation too in that the mom first noticed the
symptoms on 4/1 but no-one followed this up until 4/7 - this is six days and
it seems that the very first days are crucial - was the mom given
information on 4/1 on the urgent need to keep the breast very well drained?
I'm convinced that the potential for abscess occurs within 3 - 4 days of the
first symptoms - if mastitis is "left" at that time then what follows is
simply a domino effect, it gradually becomes worse and worse.  Interesting
that this does not happen with every mastitis of course, but the ones that
progress to abscess usually show *with hindsight* that the breast was not
well drained, or that antibiotics were late in being prescribed (although
this doesn't apply in your case).  Amoxicillin is the antibiotic which is
usually prescribed for mastitis here, but it seems to me that a prescription
for an antibiotic is not sufficient to prevent an escalation, the mother
needs information on drainage *right at the beginning* and follow-up, daily
if necessary, to ensure that this is happening.
I think the fact that she got so sick when the dicloxacillin was started was
just a coincidence, the abscess was already there by that time, and I don't
see how the fenugreek could have made any difference.

What is really nice, in the midst of such a distressing scenario, is how you
were able to "manage" lactation before and after the surgery, and how
receptive the surgeon was - this sounds like a text-book ideal for how to
manage lactation during a breast abscess.  I have found when the abscess is
situated under the areola that lactation seems to be badly affected even
after healing takes place and the mom may elect to continue unilateral
breastfeeding on the unaffected breast.  However I have one at the moment
who is still pumping on the affected breast, four months after surgery,
obtaining about 10 ml EBM each time, bless her.  The baby cannot often be
persuaded to nurse from the affected breast because the "flow" is so slow -
but mom perseveres in coaxing him.

Thank you Becky for sharing this case with us.  My regrets, everyone, for
the long reply - this was too rare an opportunity to compare notes to miss!

Pamela Morrison IBCLC, Zimbabwe