I would be grateful to hear from anyone with experience or knowledge of this.

I saw a mother 6 weeks ago with very sore abraded nipples, due, I
believed, to tongue tie in her baby.  She was not interested in it
being snipped; I helped her with latch, and she used nipple shields to
protect them.

I was away, and returned to find she has had recurrent mastitis in one
breast ever since.  Culture recently was negative. It has been treated
with repeated courses of penicillin (amoxyclav, I think) and she has
had regular intensive physical therapy - ultrasound and vigorous
massage, getting pus from the nipples.

I feel a hard tender diffuse mass in the breast, which is entirely
swollen, similarly to engorgement; but there is no heat, redness, pain
or fever.  Ultrasound reveals
"a >6cm subareolar mass which is broad-based posteriorly with the
point towards the nipple. It has small pockets of fluid <1cm dia
within it. There are no signs of increased blood flow. The features
are those of an inflammatory phlegmon. Drainage is not feasible." The
radiologist suggested wait and reassess in six weeks time.

I have not encountered this before.  I am thinking it might have been
caused by the vigorous massage (mom described it as mauling her
breast), and will tell her not to have any more.   I am wondering if
it is heading to an abscess, and if more antibiotics now would help
prevent that, despite no culture to go on?  What is your experience?

She seems to be getting more amenable to having this tiny snip now. I
just wish she'd had it 6 weeks ago.

Nan

Nan Jolly MB BCh. IBCLC. LLLL
Port Elizabeth, South Africa

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