Fortunately, a rare complication of breastfeeding, breast abscess can result from untreated or poorly treated infectious mastitis. It requires rapid management combining antibiotic treatment and drainage of the abscess.
What is breast abscess?
Breast abscess is the formation of a purulent collection (an accumulation of pus) in the mammary gland or periglandular tissue. The abscess most often results from infection with Staphylococcus aureus. This infection can follow various complications of breastfeeding:
- most commonly, untreated or poorly treated infectious mastitis (incomplete breast drainage, unsuitable antibiotic or treatment shortened)
- a superinfected crevice, which presents a gateway for pathogenic germs.
Thanks to the good management of mastitis, breast abscess fortunately remains a rare pathology, affecting only 0.1% of breastfeeding mothers.
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What are the symptoms of a breast abscess?
Breast abscess manifests itself by very specific symptoms:
- the presence in the breast of a hard, well-defined, warm mass
- severe throbbing pain, increased on palpation
- a swollen breast that is tight and has a red color on the affected area, sometimes with a paler central area. Shiny at first, the skin may then peel or even crack, letting the pus drain
Faced with these symptoms, it is important to consult as soon as possible.
How to diagnose breast abscess?
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. These elements are important for the choice of treatment.
How to treat a breast abscess?
A breast abscess cannot be resolved on its own, nor with “natural” treatment. It is a medical emergency requiring rapid treatment in order to avoid sepsis, a serious complication. This treatment is multiple:
- an anti-inflammatory analgesic treatment compatible with breastfeeding, to relieve pain
- general antibiotic treatment (amoxicillin / clavulanic acid, erythromycin or clindamycin combination) for a minimum of 14 days in order to eradicate the germ in question. This treatment can be adapted depending on the results of the bacterial analysis of the puncture fluid.
- a puncture-aspiration of the pus using a needle to drain the abscess. The procedure is performed under local anesthesia and under ultrasound control. Once the pus is completely drained, an irrigation of isotonic solution (a sterile saline solution) is done to clean the abscess, then a bandage 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), does not induce an unsightly scar and does not require hospitalization (and therefore no mother-baby separation), ultrasound-guided puncture-aspiration is the first treatment intention of breast abscess.
- in the presence of an abscess larger than 3 cm in diameter, a percutaneous drain can be placed under ultrasound, in order to perform daily rinsing.
- in the event of failure of the ultrasound-guided puncture-aspiration (very viscous pus, partitioned abscess, large number of punctures, very severe pain, etc.), a large or deep abscess or a recurrent or chronic abscess, drainage surgery is necessary. After incision of the skin under local or general anesthesia, the surgeon scrapes the shell of the abscess with his finger in order to remove the majority of the cubicles (the micro-abscesses located around). He then irrigates the area with an antiseptic solution before setting up a drainage device (gauze wick or flexible plastic blade) in order to evacuate the various liquids (pus, blood) during the healing process, but also to keep open abscess. This is important in order to obtain progressive healing, from the inside to the outside, and avoid recurrence. Local care will be provided daily, and analgesics prescribed.
Can you continue to breastfeed with a breast abscess?
Since prescribed antibiotics 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, in other words, if the baby’s mouth is not too close to the puncture site. Breast milk is generally free from pathogens. The mother will simply make sure to wash her hands well before and after feeding and to put a sterile compress on the puncture site during the feeding so that the baby does not come in contact with the pus. If the feeds are too painful, the mom can use a breast pump while the baby heals to avoid engorgement which can cause the abscess to persist.