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Subject:
From:
Shirley Gross/Les Wallace <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 15 Feb 1997 15:03:14 -0700
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The mother recently described by Evelyn Landry is a typical case study of a
breast abscess in the lactating mother.

(this mom 1st had 1 sore nipple)

I assume that there is some element of nipple damage causing the pain.
Nipple wounds often go on to become colonised and then infected with
staphlococcus.  The nipple wound becomes larger and the patient often
develops mastitis. Unfortunately, as long as there is a nipple wound, staph
can reinfect the nipple, causing more damage and mastitis.  This might
account for the second mastitis.

This mother also had mastitis with the previous child, so there might also
be other factors that will increase the risk of mastitis, such as an
overabundant milk supply.

(Next mastitis - She used heat, massage, hot showers, nursed often,
pumped  - Dr. put her on antibiotics seemed to clear up.)

(She called back to say she developed another area on her breast - Dr. did a
needle biopsy
withdrew "pus" put her on a different antibiotic, told her to come back in 3
days to determine if it was necessary to open and drain the area.)

The alternative to an incision and drainage would be to aspirate the abscess
daily, under local anaesthesia and then gradually decrease the frequency
until there is no more fluid or only clear milk is obtained. (This doctor's
needle biopsy was a good intervention!)   We have treated six patients with
this method.  One patient had an abscess that really undermined her nipple
and shut down the breast.  She continued to nurse on the non-affected side
and had a full supply for the baby.  All of the other patients continued to
nurse on both sides.  We never had to go to incision and drainage for any of
them.  All mothers stayed on antibiotics until we were certain the abscess
was cleared.

I always explain to mothers that an abscess is like a giant pimple.  Once
you let the pus out, by what ever means, they get better.

I have added on a part of an article I recently wrote on nipple and breast
pain.   You are welcome to copy and distribute it but could you please add
my name, title and affiliation (Director, Edmonton Breastfeeding Clinic,
Assistant Clinical Professor, University of Alberta) and cite the article.

__________________________________________________________

An abscess of the breast will present as a painful breast mass that does not
change significantly with breastfeeding.  There is usually a prior history
of a partially resolved mastitis. Although ultrasound can be useful for
diagnosis, it can also produce false negatives.

The traditional treatment for abscesses has been incision and drainage.
Unfortunately this results in hospitalization, general anaesthesia and an
open breast wound.  Breast incision and drainage can also result in fistula
formation and duct transection.  Breastfeeding is often terminated as the
child is not usually admitted with the mother and the woman cannot easily
nurse with a breast wound.

There are reports in the literature recommending daily needle aspiration for
the treatment of breast abscesses (1) and we have had great success with
this method.  Although the patient must be seen  frequently, all of the
above hazards involved with general anaesthetic, hospitalisation and
surgical incision are eliminated.  The patient also receives oral
antibiotics until the abscess is cleared.

When possible the mother should continue to nurse on both the normal and the
affected breast, irrespective of the way the breast is drained.  Abscesses
often result in a significant decrease in milk production on the affected
side.  Accordingly infants must be monitored to ensure adequate weight gain.
Abccesses under the nipple can also cause an inverted nipple that tends to
settle with time once the abscess resolves.

1.  Karstrup S, Solvig J, Nolsoe CP, Nilsson P, Khattas S, Loren I et al.
Acute puerperal breast abscesses:  Ultrasound guided drainage.  Radiology
1993;188:807-9.


from  Gross M S.  Pain in the breastfeeding mother. Can J CME
1997;9(7):129-36.
_______________________________________________________

M. Shirley Gross M.D.,C.M., C.C.F.P.
Director, Edmonton Breastfeeding Clinic
Assistant Clinical Professor
Dept. of Obstetrics and Gynaecology and Dept. of Family Practice
University of Alberta

16729 - 100 St.
Edmonton, Alberta
Canada T5X 3Z9
Ph (403) 456-9565
Fax (403) 478-7796
E mail  < [log in to unmask] >
_______________________________________________________

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