Yes---there is a difference between mastitis involving bacterial infection
and not.  But the problem is it can be difficult to tell.

I find that frequent removal, heat, massage and castor oil packs usually
clear a plug in 12-24 hours...even if mom has fever and nausea and redness
on the overlying skin.  So I do not tend to prescribe antibiotics until she
has tried these measures.

Times that I WILL use an antibiotic right away are if there are open wounds
on the nipples OR mom has had systemic symptoms for several days before
seeking my help.

As for incision of abscess vs needle aspiration, I do not do either.  But
the surgeons I refer to will do either one.  Usually they try one or two
needle aspirations.  If it does not clear with that, they incise.  But even
if they DO make an incision, they do NOT need to wean!!

Kathy Leeper, MD, IBCLC
Medical Director, MilkWorks

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