I have a client whose baby is now 6 weeks old.  Mum has had always had a lot of difficulty in attatching baby to the left breast and uses nipple shields for both breasts all feeds.  Has had one 2 episodes of mastitis in left breast, the first cleared well.  The second presented 10 days ago and rapidly developed.  Antibiotics were commenced and Mum elected to have regular ultrasound of that breast daily as well as following all the usual management of mastitis.  By 5 days the red area was worse and Mum went to her gp, who was not concerned.  By day 8, the red area was the size of a tomato, no other symptoms of mastitis evident.  Mum saw her GP again who referred her to a surgeon who then and there did an I and D of the abcess.  Discharge was sent for culture and the correct antibiotics she was using were fine.  I can't understand why this mum develped an abscess, she was so diligent and did everything to clear up the infection, why did it progress.?  Was it the ultrasound?  The other thing is that she has always only been able to express 25 mll out of the problem breast but gets 120 out the good side.  Milk only comes from one pore on the affected side.  This is mums second pregnancy, she lost her first child at birth.  She had no mastitis or any breast problems after that birth.  She has a history of fibrocystic disease.  Mum is very concerned about why this has happened, I don't know.  She is also concerned that she has breast cancer and that is why this has happened.  She has a history of breast cancer in her family.  Can any one shed some light on this.  Also she has weaned her baby off the bad side but is expressing it.  How long should she continue to express.  She is just expressing for comfort, but the breast is not really ever full anyway.
Val in Busselton, Western Australia
RN RM IBCLC

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