Marianne,

I am just now recovering from a bacterial infection-caused case of
mastitis that did form an abscess. While I didn't see a specialist, my
family practitioner is fairly knowledgeable about breast issues. The
strange thing is that I am not lactating, nor have I for about a year
and a half, so there was some concern about inflammatory breast
cancer. But I had a lump that grew fast, which was more indicative of
an abscess, and seemed to be.

She prescribed 500 mg cephalexin qid for 7 days and that seemed to
*mostly* clear up the abscess as well as the inflammation and pain.
That said, I am three days past my last dose, and there is still some
firm tissue in my breast, though I don't think any pus remains. It is
*much* smaller--at it's largest I would estimate it was approaching
the size of a lemon. When the Dr. learned it was markedly better but
not completely resolved, she suggested waiting a week without further
antibiotics before recommending anything else. I do know that she
would insist on an ultrasound and mammogram before she tried draining
or excising the abscess. In fact, she said that they prefer never to
excise from the breast due to the ductal structures. Which was
interesting because I don't plan on having any more children, but am
still of childbearing age (for a little while longer anyway, lol). So,
anyway, it would seem that the conventional wisdom (or at least hers)
is not keen on cutting into breasts. I don't know what her
recommendations would have been had I been nursing, but I suspect she
wouldn't have recommended weaning.

So, to directly weigh in with my opinion on the 2nd question, so far I
am cautiously optimistic that neither incision nor draining is
strictly necessary in the case of an abscess. As to the 1st question,
I have always been of the opinion that bacteria is the cause of
mastitis per se, generally as a result of milk stasis (though
obviously not always), but that the milk stasis and subsequent
swelling, redness, discomfort is not necessarily mastitis but could
easily become so if not properly managed.

Gina Gerboth
Pueblo, Colorado, 2008 IBCLC Hopeful

On Jan 24, 2008 6:07 AM, Marianne Vanderveen-Kolkena
<[log in to unmask]> wrote:
> First question: do you agree that it is relevant to differentiate between these two?
> Second question: in case of an abscess, could needle aspiration do the trick to solve it or does it absolutely need an incision to drain the site and get rid of the pus (with or without a drain placed)?

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