Fortunately, breast abscess is a rare complication of breastfeeding. It can follow an untreated or badly treated infectious mastitis. It requires rapid management combining antibiotic treatment and drainage of the abscess.
What is a breast abscess?
A breast abscess is the formation of a purulent collection (an accumulation of pus) in the breast gland or periglandular tissue. The abscess is most often the result of a Staphylococcus aureus infection. This infection can follow various complications of breastfeeding:
- most commonly, untreated or poorly treated infectious mastitis (incomplete breast drainage, inadequate antibiotics, or shortened treatment);
- a superinfected crevice, which presents an entry point for pathogenic germs.
Thanks to good management of mastitis, breast abscesses are fortunately still a rare condition, affecting only 0.1% of breastfeeding mothers.
What are the symptoms of a breast abscess?
Breast abscesses have very specific symptoms:
- the presence of a hard, well-defined, warm mass in the breast
- intense, pulsating pain, increased on palpation;
- a swollen, tense breast with a red coloration in the affected area, sometimes with a paler central area. The skin is initially glistening, but may later peel or even crack, allowing pus to drain out;
When faced with these symptoms, it is important to consult a doctor as soon as possible.
How is a breast abscess diagnosed?
In addition to the clinical examination, an ultrasound is usually performed to confirm the diagnosis of breast abscess, measure the abscess and specify its location. This is important for the choice of treatment.
How is a breast abscess treated?
A breast abscess cannot be resolved on its own, nor with a “natural” treatment. It is a medical emergency that requires rapid treatment to avoid sepsis, a serious complication. This treatment is multiple:
An anti-inflammatory analgesic treatment
An anti-inflammatory analgesic treatment compatible with breastfeeding, in order to relieve the pain.
Antibiotic treatment (combination of amoxicillin/clavulanic acid, erythromycin or clindamycin) by the general route for a minimum of 14 days in order to eradicate the germ involved. This treatment can be adapted according to the results of the bacterial analysis of the puncture fluid.
A pus aspiration is performed with a needle to drain the abscess. The procedure is performed under local anesthesia and ultrasound control. Once the pus is completely drained, an isotonic solution irrigation (a sterile saline solution) is performed to clean the abscess, then a dressing is applied to absorb the pus.
It is often necessary to repeat this puncture several times (2 to 3 times on average) in order to achieve total resorption of the abscess. Non-invasive (and therefore less likely to damage the mammary gland), not inducing unsightly scarring and not requiring hospitalization (and therefore no separation of mother and baby), ultrasound-guided puncture-aspiration is the first-line treatment for breast abscess.
Placement of a drain
In the presence of an abscess of more than 3 cm in diameter, a percutaneous drain can be placed under ultrasound, in order to perform a daily flushing.
In case of failure of the ultrasound-guided puncture-aspiration (very viscous pus, cloisonné abscess, important number of punctures, very important pain…), of a large or deep abscess or of a recurrent or chronic abscess, a surgical drainage is necessary.
After incising the skin under local or general anesthesia, the surgeon scrapes the abscess shell with his finger in order to remove most of the lodges (the micro-abscesses located around). The surgeon then irrigates the area with an antiseptic solution before placing a drainage device (gauze wick or flexible plastic blade) to evacuate the various liquids (pus, blood) during the healing process, but also to keep the abscess open.
This is important in order to obtain a progressive healing, from the inside to the outside, and to avoid recurrences. Local care will be given daily, and painkillers prescribed.
Can I continue to breastfeed with a breast abscess?
Since the antibiotics prescribed are compatible with breastfeeding, the mother can continue breastfeeding with the unaffected breast. On the affected breast, continued breastfeeding is possible if the abscess is not periareolar, that is, if the baby’s mouth is not too close to the puncture site. Breast milk is usually free of pathogens.
The mother will simply make sure to wash her hands well before and after the feeding, and to put a sterile compress on the puncture site during the feeding so that the baby is not in contact with the pus. If the feedings are too painful, the mother can use a breast pump during the healing process to avoid engorgement, which can make the abscess persist.