To Kathy Bell,

When I worked in Zimbabwe I looked after several mothers
who presented with large breast abscesses. I would incise
and drain such abscesses, and if they were at all large they
would be packed and the wound left open.  (If the wound
had been closed with, say, a drain left in place, it is
likely that the infection would have become worse since
such a drain, in such a position, is rarely effective,
and allows blood and pus to collect in the wound cavity.)

These wounds invariably leaked milk, and invariably
healed.  I used to ensure that the dressing tape was not
placed over the nipple and the mothers would continue to
breastfeed their baby from both breasts. I never incised
very close to the areola.

So please reassure this mother that, although she sounds
to have had a horrid time, that her management has been
correct and that she can expect to heal up quickly now.
Why did she have Amoxycillin in the first place, I
wonder, rather than an antibiotic that would be effective
against staph aureus, such as flucloxacillin?

Interestingly these large breast abscesses were the only
breast problems that I saw.  They generally ocurred once
breastfeeding was well established and I rarely saw women
with sore or cracked nipples.  Abscesses at many body
sites, including in the muscles, were common in this
population.

Best wishes



Wendy Holmes