Abcess

Definition

A walled off area of infection (pus), with no drainage route to the outside of the body.

Symptoms

• hard, painful area in part of the breast
• may have fever, chills or sweats
• overlying skin may appear tight
• may have redness over the skin

Diagnosis

Ultrasound (non-invasive) or fine needle aspirate (done by a breast surgeon).

When to worry that you may have an abscess:

For mastitis patients, if fever has not gone down or the hard area has not decreased in size, speak with your doctor.

1. Generally speaking, fever should significantly decrease in the first 24 hours after starting antibiotics, and temperature should be normal within 48 hours.
2. The hard area should decrease in size and should be completely cleared within 1 to 2 weeks.

For blocked duct patients, if the duct has not significantly decreased in size after 5 days, speak with your doctor about taking antibiotics. If it still does not improve with antibiotics, you should speak with your doctor about getting an ultrasound.

Treatment

Once an abscess is diagnosed, it must be surgically drained. Depending on the severity of the abscess, this may be done in the office or in the operating room. The drainage site may have to be packed with gauze for a few days until it heals. It is not unusual for milk and pus to leak from the drainage site.

**Many women continue to nurse after an abscess is drained. A breast surgeon will attempt to make the incision as far away from the areola as possible in order not to interfere with nursing. IF you choose not to nurse on that side, see Weaning page for instructions.

Prevention

Call your doctor whenever you have a fever and breast pain.Call your doctor if you are on antibiotics for mastitis but are not improving.Call your doctor if you have a blocked duct that has not resolved after 4-5 days.Make sure to empty the breasts regularly.

Breasts do not react well to changes in routine. If you skip a feeding or have gone longer than usual between feedings, the next time you feed or pump, you need to make sure you drain the breasts very well.

• Massage them during the feeding/pumping.
• If nursing, perhaps pump after that feeding to fully drain the breast.
• Put an ice pack over the breast for 20 minutes after it is drained.
• Take one 600mg dose of ibuprofen (only if you have don't have a history of kidney problems, stomach ulcers or gastritis).