I saw a mother recently who was referred to me because of shooting pains in her breast
and breast refusal from that side (inverted nipple). Baby 10 weeks old when they saw
me.
Over the phone I wondered about thrush (mum treated for mastitis 5 days postpartum).
On seeing the mother, she said that shooting pains had begun 3 weeks ago, and baby
had suddenly refused that breast. She was otherwise well and had no fever, signs of
mastitis etc. She had noted that milk from that breast seemed more yellow and
thicker, and had been told by her usual doctor that this was 'usual' if breast
wasn't fed from.
When I saw the breast, it was really firm, slight redness around areola and when
she expressed it was yellow - not milk, but pus (yuk). Ultrasound confirmed an
abscess, which was surgically drained of 450ml (16 oz) of pus the same day.
It was interesting that the first signs of an abscess was breast refusal rather
than obvious signs of breast infection. I guess that this mum had this abscess
grumbling away for some time. Her husband had also tasted the 'yellow milk' when
it first appeared 3 weeks ago, and said it was salty. When they fed it to baby
via a bottle, baby vomited (not surprisingly !!).
Mum is now recovered, but is not keen to continue lactating from that breast in
fear of another abscess. I have encouraged her to keep up one sided feeding, as
she fed her first child for over 12 months.

I suppose this has taught me that what appears to be refusal, thrush or other
problems can be underlying breast infection, even if the signs are subtle.

Fiona Coombes MBBS IBCLC
Perth Western Australia