A fortunately rare complication of breastfeeding, breast abscess can result from untreated or poorly treated infectious mastitis. It requires rapid treatment combining antibiotic treatment and drainage of the abscess.

What is a breast abscess?

A breast abscess is a formation of a purulent collection (an accumulation of pus) in the mammary gland or periglandular tissue. The abscess most often results from a Staphylococcus aureus infection. This infection can result from various breastfeeding complications:

most frequently, untreated or poorly treated infectious mastitis (incomplete breast drainage, unsuitable antibiotic, or shortened treatment);

A superinfected crevice, which presents an entry point for pathogenic germs.

Thanks to the good management of mastitis, breast abscess, fortunately, remains a rare pathology, affecting only 0.1% of breastfeeding mothers.

What are the symptoms of a breast abscess?

A breast abscess is manifested by very specific symptoms:

the presence in the breast of a hard, well-defined, warm mass;

intense throbbing pain, increased on palpation;

a swollen, tense breast with a red color on the affected area, sometimes with a paler central area. Shiny at first, the skin can then peel, or even crack, letting the pus flow out;

fever.

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 generally 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 resorbed alone, nor with a “natural” treatment. It is a medical emergency requiring rapid treatment in order to avoid sepsis, a serious complication. This treatment is multiple:

Anti-inflammatory analgesic treatment

An anti-inflammatory analgesic treatment compatible with breastfeeding, in order to relieve pain.

Antibiotic treatment

Antibiotic treatment (combination of amoxicillin/clavulanic acid, erythromycin, or clindamycin) systemically for a minimum of 14 days in order to eradicate the germ in question. This treatment can be adapted according to the results of the bacterial analysis of the puncture fluid.

A puncture-aspiration of pus

A puncture-aspiration of the pus using a needle to drain the abscess. The procedure takes place under local anesthesia and under ultrasound control. Once the pus has completely drained, irrigation of isotonic solution (a sterile saline solution) is performed to clean the abscess, then a dressing 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), not inducing unsightly scars, and not requiring hospitalization (and therefore no mother-baby separation), ultrasound-guided puncture-aspiration is the treatment of first intent of breast abscess.

Installation of a drain

In the presence of an abscess more than 3 cm in diameter, a percutaneous drain can be placed under ultrasound, in order to perform daily rinsing.

Surgical drainage

In the event of failure of ultrasound-guided puncture-aspiration (very viscous pus, septate abscess, a large number of punctures, very significant 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 scratches the shell of the abscess with his finger in order to remove the majority of the cells (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 the open abscess.

This is important in order to obtain progressive healing, from the inside out, and to avoid recurrences. Local care will be provided daily, and analgesics prescribed.

Can you continue to breastfeed with a breast abscess?

With the prescribed antibiotics being 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 of pathogenic germs.

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 into contact with the pus. If feedings are too painful, the mother can use a breast pump while the patient heals in order to avoid engorgement which can promote the persistence of the abscess.