Breast Abscess in Lactation

Abstract

A.B. is a 29‐year‐old gravida 1 para 1001 who experienced recurrent lactational breast abscess requiring surgical treatment. Her obstetric, medical, surgical, family, and social histories are unremarkable. She takes no medications and does not use alcohol, tobacco, or drugs. She gave birth at 41 weeks'gestation to a female infant, weighing 8 pounds 5 ounces. Her intrapartum course and immediate postpartum course were within normal limits. Breastfeeding was initiated within 40 minutes of birth and was successful. Her infant nursed on demand approximately every 2 to 4 hours while in the hospital. A.B. was discharged home with her baby at 28 hours postpartum. On day 3 postpartum, A.B.'s left nipple became cracked and bleeding. This was self‐treated with lanolin ointment and correction of latch‐on technique. Ten days postpartum, A.B. was diagnosed with mastitis and treated with dicloxacillin for 10 days. After 8 days of antibiotic treatment, she reported continued breast pain with a firm area of exquisite pain and redness in the upper outer quadrant of her left breast. The midwife ordered a breast ultrasound which revealed a 4‐cm abscess in the left breast. A.B. was referred to a therapeutic radiologist who performed an ultrasound‐guided needle aspiration of the abscess and obtained 15 mL of fluid. The fluid culture was positive for Staphylococcus aureus. She was treated postprocedure with doxycycline, and the breast pain, firmness and redness resolved within 36 hours. The rationale for treatment with doxycycline is unknown and subject to inquiry because S aureus is not sensitive to doxycycline.1 Two weeks after the procedure, the abscess returned, and she was again treated with ultrasound‐guided needle aspiration and a regimen of amoxicillin with clavulanate. The abscess partially resolved, but worsened 6 days later. At that time, A.B. was referred to a breast surgeon who surgically incised and drained this 6‐cm abscess under general anesthesia. She was discharged home the same day with an indwelling Penrose drain. Two days later, the drain was removed and the wound was healing normally. A.B. continued breastfeeding exclusively throughout all of these events and was completely healed by 3 weeks after the incision and drainage. At 5 months postpartum, she had not experienced further breast infections and was continuing to breastfeed her baby.

Trends in non‐lactation breast abscesses in a tertiary hospital setting

“…Complications associated with longer hospital stay include respiratory tract infections, urinary tract infections and thromboembolism. The development of chronic fistulae and SMOLDs is likely to be potentiated in smokers due to delayed tissue repair resulting in recurrence of abscess . Recurrences yet again worsen chronic inflammation amplifying complications further.…”

“…in 1951 as fistulas of lactiferous ducts that resulted in chronically draining sinus and abscess formation, typically around the areola . The role of squamous metaplasia of the lactiferous duct (SMOLD) epithelium, duct obstruction and subareolar duct dilation or duct ectasia has also contributed to the pathogenesis of breast abscesses . Complications include severe, necrotizing infections and sepsis, and may be prevented by timely treatment.…”

Opinions of midwives regarding the introduction of breast ultrasound in mothers’ breast care

“…However, even with professional breast care, the mother's breast condition may deteriorate (Martin, 2009). There are various reasons for the deterioration: 1) the child cannot suck well, 2) the mother's mammary glands are clogged, 3) the mother's milk amount is large, and 4) the mother's breast is inflamed.…”