> Yesterday the mother had a hospital appt where the lump was checked using
> ultrasound. The doctor said the lump was an abcess and drained it using a
> needle. The mother started another course of antibiotics and goes back for a
> follow-up check next week. Is it possible to be certain this was an abcess
> from ultrasound and draining fluid? Could it have been a galactocele or is
> that unlikely?

That depends of what came out when draining: milk or ''infection products''
(don't know the correct English term, this is the exact translation of Dutch).

> The mother would really like to keep breastfeeding, but doesn't want a
> repeat of the abcess or any other problems, especially since she is
> returning to work part time in a week or two. The hospital doctor told her
> that continuing to breastfeed would mean the abcess is more likely to recur
> than if she weaned completely. Is this true - have studies been done?

Mastitis and absesses may recur if the cause is not removed or cured, regardless
of the mother continues to breastfeed or not. Does the doctor have studies that
indicate that breastfeeding will increase the risk for recurrence? I would be
interested to read that. Think it would urge the IBLCE to rethink some of the
exam questions...
Returning to work is a stress-factor. Weaning just prior to or coinciding with a
risk factor would IMO enhance the risk for plugs, mastitis and worse.

> If the abcess is likely to recur on this side, would it be possible to wean
off the
> affected breast and let it dry up and feed just from the other breast? The
> doctor told the mother that any breastfeeding would mean both breasts
> continue to make milk but I thought this was not the case?

If one breast keeps getting into trouble and nothing works, than weaning from
that breast is very well possible, as milk production after the first days
mainly depends on emptying the breast. If the breast is not emptied, or
progressively emptied less and less, milkproduction in that breast will stop,
while it goes on in the breast that is emptied (in fact production here will
rise, for there will be more milk taken from this one). But I really don't think
that is the solution in this case.

> At the moment, the mother hasn't breastfed or expressed either breast since
> yesterday. I have suggested she express, at least to comfort, to avoid
> getting mastitis in both breasts from engorgement.

And then the trouble would only realy start for her!

> As I said, the mother would prefer to breastfeed but will continue with
> total weaning if it means less likelihood of another abcess. She also
> doesn't know whether the original blockage has cleared and how to shift it
> if it is still there. Can anyone give me some information and suggestions to
> help her?

You might want to sort out with her what could have caused the
plug/mastitis/abcess and subsequently on ruling this factor(s) out the prevent
recurrence. Could be feeding in another position, wearing another bra-model,
shoulder-bag, sling etc, or perhaps the way she expresses milk.

Good luck being a nursing-detective!

Gonneke van Veldhuizen, IBCLC, living in Maaseik, Belgium
http://www.users.skynet.be/eurolac
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