I would run cultures for yeast and bacteria of both the nipple and the milk
(maybe too late for them given the antibiotic unless her response to the
antibiotic is slow). Lawrence states that recurrant plugs can be caused by yeast
so you could try emperic treatment for yeast. Yeast should grow from the
nipple tissue as long as no milk is expressed during culturing and she is not using
bactroban or anti-fungal topically. Could the sebacious cyst actually be a
small abscess? Maybe she needs an ultrasound to look for an abscess or
galactocoele--deep plug? I once had a mom with recurrant mastitis who once I
cultured her and got her and the baby treated (it grew out strep) long enough (3
weeks the followed by low dose erythromycin) she finally expressed a large plug
and has been symptom free since. Good luck. Chris
Christine Betzold NP IBCLC MSN
www.theBFclinic.com
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