Fiona posted sev. days ago about a mom with a draining abscess who was
(understandably) upset at the milk draining from the incision cite.  I have
had exper. with  6-7 of these cases.  The first I saw yrs ago while in
practice with a pedi. who had done his undergrad work in biol at a
mid-western US (farm country) univer.   His particular mentor was a vet who
was a specialist in bovine abscesses.  I was very grateful for his insights
into the way we managed our patient.  She was a multip. Got what felt like
plugged duct very early on (about Day 5 as I recall).  It must have walled
off very quickly and formed abscess.  By-passed most of the early warnings
signs of mastitis, etc. and rapidly presented as enlarging mass.  By then
antibiotic therapy was useless (tho it was initiated) and she was sent to
surgeon for treatment -- incision, shunt to drain, standard stuff.  Of course
this was frightening and looks very gross -- quite a mutilating exper. for
the mother and her whole family.  It was distressing to have the wound drain
milk every time she let down on the other side. or when she pumped the
surgically affected side.  The pedi remarked, however, that this was GOOD.
 This would bathe the incision in all the beneficial anti-inflammatory,
anti-infective etc properties in the milk.  Tissue would remain pink and
healthy, and wound would close a bit more slowly.  This would prevent a
situation where a fistula could form of pooled milk which could dam up behind
a thin membrane of new tissue (which might burst and tear doing a lot of
damage if too much milk pressure accumulated behind it.)  He said that
keeping the center of the wound cite open and letting things granulate from
bottom up and sides in towards middle was best shot at good healing and the
slow closure ensured by the milk drainage would promote  that. We used
Lactina to keep that breast comfortable and slowly weaned supply down.  As
things recovered, she began nursing from it again and did well.

I have seen that happen now enough times that it seems reasonable to count on
it.  Mothers seem to be able to accept this explanation.  I have seen 4 moms
nurse through such an exper.  Some elect to slowly wean down the affected
breast on a pump and continue on the good side.  Two have weaned totally.  I
am currently working with a mother who had the exact scenario above with Baby
# 1  19 mo ago.  She began with no fever, just pea size lump which OB
assessed as plug.  Within 4 days lump was size of egg.  She phoned me with
request for eval.  I told her to go instead immed. back to md, who sent her
immed. to surgeon.  First they did aspiration.  Then incision and drainage of
2 abscesses in rt breast.  She never devel. a fever until entering surgeons
office. She elected to wean at this point ( very gradually under my
supervision.) 5 mo down the road from surgery she continued to have
tenderness and plugged feelings under one of the incicions (the superior one)
and more surgery was done to remove a galactocele.

She just delivered baby #2 around Christmas.  Same breast is now exhibiting
plugs.  She has seen surgeon and is on prophylactic meds for mastitis.  I am
helping manage over-supply and practically sitting on her to keep her from
over-doing.  I believe many of her probs. are related to very active
personality type and refusal to allow herself to rest and recover.  The plugs
are in a diff. quadrant of the breast than the original ones, and perhaps
there is something about this breast (kinky ducts?)

Hope this sharing helps, Fiona.  These are scary cases to manage.

Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Tx