> THIS IS A MESSAGE IN 'MIME' FORMAT. Your mail reader does not support MIME. > You may not be able to read some parts of this message. --PART.BOUNDARY.24.808799090 Content-ID: <24_63_1_808796797> Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit 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. // --PART.BOUNDARY.24.808799090 Content-ID: <20_808800209_2_edmbfc1> Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit --PART.BOUNDARY.24.808799090 Content-ID: <20_808800209_3_edmbfc1> Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit --PART.BOUNDARY.24.808799090 Content-ID: <20_808800209_4_edmbfc1> Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit --PART.BOUNDARY.24.808799090--