Lactational Abscess: How Deep Can It Go?

 

Helping mothers learn to breastfeed at times can be challenging. Because breastfeeding is considered a natural process, it is often assumed that infants will simply know how to latch easily to their mothers’ breasts.

When I teach breastfeeding instruction to pregnant mothers, I want to boost maternal confidence in being able to breastfeed, and to educate mothers about common breastfeeding problems, and how and when to seek professional help.

Sore Nipples

Persistent nipple pain and nipple damage is one of the most common reasons for mothers to stop exclusive breastfeeding.  Jacqueline Kent et. al. published an article in the International Journal of Environmental Research and Public Health in 2015 which aimed to determine the incidence of nipple pain, and its causes and treatments. [1]

Mastitis

Many mothers with sore or cracked nipples may develop mastitis within the first six weeks after birth, although it can happen at any time. Clinical manifestation of mastitis is a very tender, swollen, and reddened area of the breast often accompanied by nipple damage.

Mothers can develop a very high temperature and experience chills and flu-like symptoms. In fact, mothers will describe their symptoms as having the worst case of the flu.

The causative agent is usually Staphylococcus aureus that enters the cracked nipple. Most mothers are treated with antibiotics and respond well within 48 to 72 hours. It is estimated about 10% of mothers with mastitis will worsen to include a breast abscess.[2]

Breast Abscess 

Though most mothers are treated effectively for mastitis, some do not recognize early signs of mastitis until it is too late to avoid a breast abscess, or may not receive ongoing treatments when symptoms of mastitis persist.

The definition of breast abscess by the Cochrane Review is “a collection of infected fluid within the breast tissue.” The aim of treatment is to cure the abscess quickly and effectively, ensuring maximum benefit to the mother with minimal interruption of breastfeeding.[3]

Treatment Choices

According to the Cochrane Review, breast abscess is treated by incision and drainage or needle aspiration. Needle aspiration is often the preferred route of treatment because there are no scars and less need for hospitalization.

Mothers need to effectively empty their breasts to optimize healing. The use of a hospital-grade (multi-user) breast pump is recommended after each breastfeeding session.

Case Presentation 

There was a mother who had an extreme case of mastitis that progressed to a severe breast abscess. She delivered her first baby and immediately experienced latching problems in the labor and delivery room.

Her labor nurse told her the latch looked good, though she was experiencing severe pain. She continued offering her breast every couple of hours during her hospital stay and hired a lactation consultant to come to her home after being discharged. But within a few days, she developed signs of mastitis, and had to call her OB for a prescription of antibiotics.

This mother had to endure several weeks of painful procedures while attempting to take care of her new baby and adjust to motherhood. Her stress levels must have been terrible! In fact, she recalls being very upset and suffering with postpartum depression and symptoms of post-traumatic stress syndrome. Her treatments consisted of intravenous antibiotics, repeated hospitalizations, breast ultrasounds, needle aspirations, and daily painful wound treatments for a large gaping hole in her breast tissue.

Conclusion

Have you ever experienced caring for a mother with a severe breast abscess? What kinds of treatments worked or didn’t work? How did the mother cope, and how did you help her? Do you think you could have done things differently? And, was her breastfeeding relationship sustained or ruined? Share your thoughts in the comments section!

Earn a nursing 1.0 contact hour or dietitian 1.0 CPE credit! Register now to view the “Lactational Abscess: How Deep Can It Go” webinar.

 

References

[1] Kent, Jacqueline et al. (2015).  Nipple pain in breastfeeding mothers: incidence, causes and treatments.  Int. J. Environ. Res. Public Health, 12, 12247-12263.

[2] Amir, L. and The Academy of Breastfeeding Medicine Protocol Committee. (2014).  ABM clinical protocol #4: mastitis, revised March 2014.  Breastfeeding Medicine, 9(5), 239-243.

[3] Irusen, H., Rohwer, A.C., Steyn, D., & Young, T. (2015). Treatments for breast abscesses in breastfeeding women.  Cochrane Database of Systematic Reviews, 2015(8); DOI: 10.1002/14651858.