Hi everyone
I saw a difficult case today, and would like some wisdom and input.
Healthy mother in late 20s had baby number one 3 yrs ago. At 6 weeks
postpartum she developed mastitis which didn't respond to
antibiotics, and then had surgical drainage with packs for 4 weeks.
She continued to bf on the unaffected side.
When 5 months preg with number 2, developed an abscess in the same
place, which burst spontaneously and was then surgically opened and
drained some more - drains in place for 4 weeks. Didn't breastfeed at
all from that side when baby born, but developed another abscess
which burst in the same spot when baby was 6 months old.  Baby was
then weaned. She has not breastfed for 18 months, but developed yet
another abscess last November which was drained and explored.
Every time this has happened, she has been treated with antibiotics,
had cultures and histology performed etc etc, but no one can explain
why this bit of breast keeps becoming apparently infected and the
scar line breaks down.
Now the breast is continually painful, the scar line seems very
fragile and often oozes clear fluid. Interestingly, the symptoms seem
much worse between ovulation and menstruation each month. She is not
on the OCP, has no history of breast pathology or trauma, and is
otherwise very healthy. No history of fungal infections. All other
family members well. No history of endometriosis, dental abscess etc
etc.
I can't explain why this lady is having so much trouble. It seems
partially hormonal, but why isn't the breast healing??
Any suggestions for this poor lady, who is so desparate that she has
asked her surgeon for a mastectomy!!!

Fiona


Fiona Coombes MBBS IBCLC               [log in to unmask]
Lactation Consultant, Family Physician
Perth Western Australia