Hello Wise Women...
I have a mom with a situation that is beyond my expertise so advice would be greatly appreciated.
This is a mom (35 y.o.) with a 4 m.o. baby who had a breast abscess drained surgically (under general) last Friday. She had a lumpectomy 2 years ago (benign) and had no further issues to that breast until after she had this baby.  baby was born at 40w5d, nsvd, no complications.  Baby lost 15% of her weight by day 3 pp.  Birth weight was 7lbs 13 ounces.  Was seen by LC in hospital, latch was fixed according to mom, and baby proceeded to gain weight normally - now at 95th percentile weighing 15 lbs.  Baby does have a "cows milk protein sensitivity" so mom has eliminated all dairy from her diet for the past 2 months.  Baby was getting neocate via bottle lately about once every other day.  I'm telling you about the history because this adds to this mom's passion for wanting to breastfeed and her overwhelmed emotional response to this abscess.
Mom told me that since baby was born she has had about 20 plugged ducts, always at the same spot (L side between 10 and 12 o'clock location).  On ultrasound they saw 2 or 3 abscesses (she was not sure) but the surgeon had ensured her after surgery that they "got it all".  Once incision was made right at the border of the areola, covering about 1/3 circumference along the top of the areola.  It is still open, packed with dressing, draining pus and breastmilk (1 week after surgery).  Baby had always preferred the right (unaffected) side and mom sometimes nursed on all 4s letting the baby drain the plugged ducts with her lower jaw. (baby facing opposite direction of mom)
Post surgery, mom still feels a "lump" at the same location as she had the plugged ducts before, about the size of a "silly putty egg".  Mom has massaged the breast, expressed manually in the shower and has used a "home made by husband" manual pump which seems to work (only covering the areola to avoid incision), and is using an electric pump for the unaffected side but has been greatly decreasing the pumping because she thinks that she needs to wean. Only pumping to relieve extreme engorgement, using ice packs as well.
So she is conflicted, the allergies that her daughter suffers with and her emotional wants for breastfeeding, vs. her extreme worry about the affected breast and the pain that comes with the infection, the wound, wound care etc. and on top of this all it is a staph infection for which she is taking antibiotics, sulfameth, for another month.  (this is also used for MRSA infection which they initially thought it was, but supposed to also be effective for the staph infection she does have).  Her biggest worry is that if she continues to breastfeed (which she has not done since the surgery) her milk will free-flow into the breast and will not have a place to go if the incision is closed.  (her surgeon told her to wean completely, she asked me if there were meds she could take to stop milk immediately, but then continued to express her deep desire to keep breastfeeding).
So this is where i need advise:
1 - is it dangerous for "infected" milk to flow into the tissue and what kind of damage could that do? or will it be fine and reabsorbed into the bloodstream and any infection killed by the antibiotics?
2 - if she continues to breastfeed on the right (unaffected) side only and slowly (to prevent engorgement which can delay healing) weans off the left side  (because she is very scared she will have more issues even after the surgery)will that be allright? (she also wants to know how long it will take for the left breast to stop making milk but i told her that is hard to predict)

Thank you in advance for your input and I hope my story is not too "all over the place"

Loes Lindsay
rn, bs, ibclc, llll
bellies and babies, inc
NY
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