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

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

• 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.

Breast abscess manifests itself by very specific symptoms:

• the presence in the breast of a hard, well-defined, warm mass;
• severe pain of a throbbing type, increased on palpation;
• a swollen breast that is tight and has a red color on the affected area, sometimes with a paler central area. Shiny at first, the skin may then peel or even crack, letting pus drain;
• fever.

Faced with these symptoms, it is important to consult as soon as possible.

In addition to the clinical examination, an ultrasound is usually performed to confirm the diagnosis of breast abscess, measure the abscess and specify its location. These elements are important for the choice of treatment.

A breast abscess cannot be resolved on its own, nor with “natural” treatment. It is a medical emergency requiring rapid treatment in order to avoid sepsis, a serious complication. This treatment is multiple:

An anti-inflammatory analgesic treatment

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

Antibiotic treatment

Antibiotic treatment (combination amoxicillin / clavulanic acid, erythromycin or clindamycin) by general route for at least 14 days in order to eradicate the germ in question. This treatment can be adapted depending on 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 is completely drained, an irrigation of isotonic solution (a sterile saline solution) is done to clean the abscess, then a bandage 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 absorption of the abscess. Non-invasive (and therefore less likely to damage the mammary gland), does not induce an unsightly scar and does not require hospitalization (and therefore no mother-baby separation), ultrasound-guided puncture-aspiration is the first treatment. intention of breast abscess. 

The installation of a drain

In the presence of an abscess of 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 the ultrasound-guided puncture-aspiration (very viscous pus, partitioned abscess, large number of punctures, very severe 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 scrapes the shell of the abscess with his finger in order to remove the majority of the cubicles (the micro-abscesses located around). He then irrigates the area with an antiseptic solution before putting in place 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 open abscess.

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

Since prescribed antibiotics are 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 from pathogens.

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 in contact with the pus. If the feeds are too painful, the mother can use a breast pump while the breasts heal to prevent engorgement which can cause the abscess to persist.