There has been so much talk about what a breast abscess looks and feels like
that I thought I'd share my policy for Breast Abscess. Please note item B
under general information.

A Lactation Consultant's Clinical Practice Manual
(c) Marie Davis  RN, IBCLC
FOR: BREAST ABSCESS

POLICY:
A.	Abscess formation in the breast shall be viewed as a serious complication
of breastfeeding requiring immediate referral to the medical provider.
B.	Determination of an abscess must be by clinical evaluation.  Telephone
diagnosis of an abscess is not appropriate.
C.	If the abscess has not ruptured into the duct system (as determined by the
medical provider), the mother will be advised to continue nursing.
D.	Pumping of the affected breast will be advised if the abscess has ruptured
into the duct system (or if the milk is contaminated) while the abscess is
being treated, provided the mother wishes to maintain a milk supply.
E.	The mother may often choose to wean when abscess formation occurs.

GENERAL INFORMATION:
A.	Breast abscess is most frequently seen in lactating women who have delayed
treatment for mastitis for more than 24 hours.  5 to 11 % of women with
mastitis will develop an abscess (Olsen and Gordon 1513).
B.	An abscess is a localized area of pus formation caused by the body’s
attempt to wall off or isolate an infection.  An elevation or pocket-like area
develops in the breast.  The area softens as the abscess reaches the skin
surface (induration).  The soft area, if left untreated, will rupture.  If the
abscess ruptures into surrounding tissue, septicemia may result.  (Berkow
A-9).  Externally the area may range from slightly pink to black in color.
Pain occurs from the compression of surrounding structures and/or cellulitis.
C.	If the abscess is well partitioned, systemic symptoms (fever, malaise,
headache, etc.) may be absent.
D.	Abscesses must always be treated by drainage.  Some surgeons may choose
needle aspiration of the abscess if it is very small.  Incision and drainage
is required for larger areas.  The procedure can be done on an outpatient
basis.  The mother may require hospitalization if the abscess is severe or if
septicemia has resulted.
E.	When the abscess is incised and drained the wound is left open (without
sutures).  A drain may be present or the wound may be packed with gauze.  It
is not uncommon for the incisional area to drain breastmilk.  Breastmilk in
the area of the incision is not harmful as the macrophages in the milk will
assist in the destruction of any offending bacteria (Auerbach and Riordan 383,
396; Lawrence 265-266).
F.	The milk will remain clean unless the abscess ruptures into the duct
system.  The incision can be covered with a clean dressing at each feeding.
In cases where the incision is on the areola, or would be involved in feeding,
the breast should be pumped at regular intervals until healing occurs in
approximately 4 to 10 days. (Auerbach and Riordan 383; Lawrence 265-266).


Olsen, Cynthia and Richard Gordon.  “Breast Disorders in Nursing Mothers.”
American Family Practice 41 (1990) 5: 1509-1516
Berkow, Robert   et al.  The Merck Manual of Diagnosis and Therapy. 14th ed.
New Jersey, Merck & Co. 1982.