Breast abscess

If mastitis is not treated properly, a collection of pus builds up in the breast tissue forming an abscess.

Antibiotics cannot penetrate into this walled off area and a lump develops. The lump may be warm and tender to touch and the overlying skin may look red. You may feel feverish and experience shivering and sweating. Surprisingly some women do not have any of these systemic symptoms and are simply aware of a persistent lump in the breast.

Ultrasound is the best way to make the diagnosis.

The pus needs to be removed and there are two ways to achieve this.

1.Aspiration of the pus with a needle and syringe

This is done immediately in the consulting room using local anaesthetic and ultrasound to guide the needle.

It is a good way to treat this problem and will avoid the need for surgery and a general anaesthetic.

You may need to return four or five times over the next few days for repeat aspiration and you will stay on antibiotics during this time.

You should continue breastfeeding and I encourage patients to see our lactation consultant for advice.

We have a 90% success rate in treating a breast abscess in this way and only a small number of difficult cases need to go to theatre for surgical incision and drainage.

2.Incision and drainage of the abscess in theatre

This is necessary if the pus is so thick it cannot be drained with a needle or if you are very uncomfortable and unable to tolerate needle aspiration.

You will require a light general anaesthetic.

Once you are asleep a cut is made in the skin over the abscess and the pus is washed out.

The cut has to be left open so that the wound can be cleaned and dressed daily for a few days to allow the tissue to heal from the inside.

We can usually arrange for a district nurse to visit you at home for the dressings.

It takes about two to three weeks for the wound to heal.

We will encourage you to continue breastfeeding during this time as it helps to prevent the breast from becoming engorged and uncomfortable.

Sometimes milk will start draining out of the wound when you are breastfeeding. This is due to connection between one of the small milk ducts and the abscess cavity and is called a milk fistula. It will heal once you stop breastfeeding and the flow of milk reduces.