Does anyone have experience with a breast abcess that was I & Ded and
left open to heal by secondary intention ?  I have been working with
a first time mother who developed mastitis several days prior to
delivery.  Her OB put her on Amoxicillin.  Two days after delivery,
six days into the anitbiotic therapy, two areas of the left breast
remained hard and were getting progressively redder.
A surgical consult was obtained, the mother placed on IV antibiotics
and continued to nurse.
24 hours later ultrasound revealed probable abcesses and surgical
incision and drainage was performed.  The surgeon did not discuss
with anyone his intention to leave the areas open to heal and
obviously assumed that this mother would discontinue nursing.  He
reluctantly agreed to "allow"  her to continue to nurse.  We tried
ice to the affected breast and no stimulation other than dressing
changes hoping that that side would dry up and the mother could nurse
on the healthy right breast.  The affected left breast contained two
open wounds in oval shapes about 2.5 x 4 cms and 2 -3 cms deep.
These were packed with gauze with dressing changes 2 times daily for
two weeks and now are just dressed with ABD pads.  One wound is at
the edge of the areola and the other is in the upper outer quadrant.
Nursing on that breast is out of the question because of the
proximity of the wound to the areola and because of pain.  Now, four
weeks postpartum, the breast is slowly healing and draining milk from
the wounds.  A recent culture grew Klebsiella so the mother is back
on antibiotics.  The surgeon is now asking her to consider weaning
totally because he is concerned that she won't heal and may develop a
milk fistula.  She does NOT want to wean and does not mind that milk
is draining from the wounds.  Three surgeons from the practice have
seen this brave lady and no one has told her that she  absolutely has
to wean but they are nervous.  My stance has been that her health
must come first.  However, I have supported her breastfeeding.
Because of the nature of breastmilk, I am not convinced that milk
draining from the wounds is a barrier to healing. I also wonder if
the pressure and engorgement from weaning would not have a greatly
detrimental effect on healing.   I have never dealt with such an
extensive open wound and I believe that none of the surgeons have
either in a woman determined to breastfeed.  So I think we are in
uncharted waters and the mother knows this.  Any suggestions?  Please
!
Kathy Bell, RN,  IBCLC