An abscess is the body’s way of dealing with an infection—by sealing it off to prevent the infection from spreading. Although rare in the breastfeeding mother, a breast abscess requires urgent diagnosis and treatment.
What is a breast abscess?
A breast abscess will usually be felt as a very painful, swollen lump, inside the breast. In the middle of the lump is an infection (a pocket of pus). The most common bacteria associated with this infection is Staphylococcus aureus. A mother may have a temperature and flu-like symptoms, and the skin on the breast above the lump may look very red or feel hot to touch. You will need to see your doctor to get a firm diagnosis and urgent medical treatment if you suspect you have an abscess but there are other causes of breast lumps when breastfeeding, you can read about some of them in Breast Lumps.
What causes a breast abscess?
A mother is most likely to develop a breast abscess if she has had a prolonged period of painful engorgement (excess milk staying in the breast) and infective mastitis (breast inflammation) that wasn’t treated promptly. Keeping the breasts comfortably drained by breastfeeding, hand expressing or pumping during a mastitis episode is the best way to avoid a breast abscess. However, occasionally a breast abscess can develop very quickly with little warning.
How to treat a breast abscess
A breast abscess can be diagnosed by ultrasound and needs immediate treatment. Abscesses can be treated by needle aspiration, catheter drainage or surgical incision and drainage of the pus. Medical opinion varies as to the best method to use depending on the size of the breast abscess. Currently needle aspiration tends to be used for abscesses less than 3cm diameter and catheter drainage in abscesses larger than 3cm 1.
A fine needle is inserted into the breast abscess and pus is drawn out with a syringe and sent away for culturing. Needle aspiration may need repeating more than once over a period of a few days and antibiotics will be needed.
Dr Jack Newman recommends catheter drainage and antibiotic treatment rather than surgical incision and drainage and shares the following plan in his latest book Dr. Jack Newman’s Guide to Breastfeeding (updated edition):
1. The abscess is located and “mapped” with ultrasound.
2. A catheter is placed in the abscess, as far as possible from the nipple and areola, and left there.
3. The mother is encouraged to continue feeding on both breasts.
4. Antibiotic treatment is continued until the catheter is taken out.
5. The catheter is withdrawn when there is no further drainage from the abscess. This can be done by a nurse who visits the mother at home.
Surgical incision and drainage
If surgical incision and drainage are needed it is important to minimise the damage to glandular tissue. La Leche League Great Britain, a breastfeeding charity, recommends:
To avoid breast tissue being damaged unnecessarily, ask for the incision to be made:
• As far from the nipple as possible.
• And from nipple to chest, rather than around the breast.
The fluid should be cultured to identify the infection so you receive appropriate antibiotics.
Can I carry on breastfeeding?
The National Health Service 2, NICE guidelines3, The Academy of Breastfeeding Medicine 4 and La Leche League Great Britain (see excerpt below) advise continuing to breastfeed during treatment of a breast abscess. It is important to keep the breast well drained. If it is too painful to breastfeed directly then try pumping or hand expressing. Some mothers continue to feed on the unaffected side while allowing the breast with the abscess to dry up. Breast milk may leak from the incision or puncture site. This is normal and will help to keep the wound clean and heal well. Covering the site with a dry, absorbent dressing—changing it as necessary—will usually be recommended by your health professional.
You can continue to breastfeed from both breasts. If the affected breast is too painful or the incision is close to your nipple you may need to hand-express for a day or two. Keeping your milk flowing will help your breast heal.
What if MRSA is diagnosed?
Staphylococcus aureus is a bacteria found on our skin that is often associated with a breast abscess. When strains of Staphylococcus aureus bacteria (staph) are resistant to the usual antibiotics they are known as methicillin or meticillin-resistant Staphylococcus aureus (MRSA). In most cases by the time MRSA is diagnosed your baby will have already been exposed to the bacteria. Breastfeeding can usually continue uninterrupted while mother, or mother and baby, have treatment—unless your baby is premature or very poorly. MRSA can be spread by skin-to-skin contact so special hygiene precautions will be needed if you have an MRSA infected wound. For further information and recommendations if you have MRSA on the breast, especially if it is close to the nipple, see Staph, MRSA and Breastfeeding.
A breast abscess is a rare condition in a breastfeeding mother and usually follows a clear period of prolonged engorgement and infective mastitis. If you suspect you have an abscess the recommendations are to keep your breast milk flowing by frequent breastfeeding, hand expressing or pumping, and seek urgent treatment from your health care professionals.