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Subject:
From:
"Shirley Gross, Md, Ibclc" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 19 Aug 1995 00:46:40 -0400
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Greetings everyone.  I am a family physician and the director of the Edmonton
Breastfeeding Clinic in Alberta, Canada.  I have recently joined LACTNET and
haven't had enough sleep since!

In response to the query from A. Montgomery regarding the patient with a
persistent breast lump - this patient might well have an abscess.  An
ultrasound is reasonably good at detecting abscesses but if the consistancy
of the abscess is the same as that of the tissue around it, it will not show
up.  The other diagnosis to be ruled out is breast cancer.  I would suggest
that this patient needs to have a needle inserted into the mass.  If pus
comes out - that is both a treatment and and a diagnosis.  If there is no
pus, she should have a needle biopsy to rule out cancer.

I recently had a case wherein a patient had a lump for three weeks with no
overlying redness and no history of mastitis or fever.  Nor did it respond to
antibiotics. The ultrasound showed only oedema. When the surgeon I work with
did a needle biopsy, she got 70 cc's of pus.

This brings me to my other point.  I have had four patients in the past year
present with breast abscesses.  All of these were managed with oral
antibiotics and daily needle aspiration until no more pus was produced and
the lump cleared.  It took ten to twenty days.  All of the patients continued
to breastfeed, none were hospitalized and we had no complications or failures
to date.  One mother developed a galactocoele that resolved within one month.

All of the patients were tremendously pleased with the procedure and outcome.
The surgeon and I really feel that this is a much better option than the
incision and drainage that has been the standard to this point.  It does
however require dedication from the surgeon and close daily follow up.

I got the idea of abscess aspiration from the article by Karstrup et al
entitled Acute puerperal breast abscesses:  US guided drainage Radiology
1993;188(3):807-9.


//---------------------------------------------------------------------------
Shirley Gross M.D.,C.M., C.C.F.P., IBCLC from the great Canadian north.
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