A breast abscess is a painful lump in the breast tissue. This is one of the most serious breastfeeding problems, but is also very rare, occurring in only about 6% of all breastfeeding mothers who develop mastitis and recurrent plugged ducts.
A breast abscess usually results when a mastitis infection has been left untreated. It occurs as a pouch within the breast that is filled with pus and is unable to drain.
A woman who has bouts of recurrent mastitis is more at risk. To prevent an abscess, mothers need to treat mastitis quickly and efficiently when it appears.
A clinical examination is needed to diagnose if a breast abscess is present. Here are the symptoms of mastitis to look out for.
Your body will try to eliminate the infection by forming a hard tissue breast mass in the infected area. Because a mother has breasts that are full of milk, the infection will continue to get worse if she is not treated.
The result, if not treated, is a mother who experiences tremendously painful, swollen breasts combined with a fever and other flu-like symptoms.
Symptoms of a Breast Abscess
- Sharp pain in the breast.
- Swollen breast lump.
- The lump is red.
- The lump feels hot to the touch.
- Mom has a high temperature and other flu-like symptoms.
- The lump does not disappear after antibiotics have been taken.
- There is pus draining from the nipple.
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What Causes an Abscess While Breastfeeding?
- The most common cause is cracked nipples. A cracked nipple may allow bacteria like Staphylococcus aureus inside the breast.
- Prevent cracked nipples with proper latching techniques.
- A diabetic mother is more likely to get mastitis, plugged ducts, and abscesses.
- Moms with previous operations on their breasts, such as lumpectomies or breast implants, are at greater risk.
- Moms who use corticosteroids are more likely to get breast infections.
- Moms who are heavy smokers also increase their chances of getting a breast infection.
Treatment of a Breast Abscess
An abscess is often quite close to the skin's surface and can be removed in a doctor’s office without surgery. This is usually done by aspiration (draining the abscess with a needle).
If the abscess is smaller than 3cm, a needle is used to drain it. Larger abscesses are drained using a catheter and done via surgery. The wound is usually left open to drain and heal.
If you have the abscess aspirated, it is best to ask your doctor to have the fluid sent to a lab so that they can prescribe the most appropriate antibiotic for you.
Some mothers have recurrent breast abscess problems if they do not get the lump surgically removed. Sometimes the abscess is too far down into the tissue and must be removed under general or local anesthetic. This is called an I&D incision and drainage.
When going for an I&D, you should always talk to your doctor about getting the incision made on a fold and from the chest wall towards the nipple, not from the nipple area; this is to prevent cutting into the milk ducts and causing damage that could affect milk supply.
If you are going for an ultrasound (to find the area of the abscess), it’s always best to drain your breasts as much as possible before the time so that the tests come out more accurately.
After Breast Abscesses Are Removed
Healing of the wound will occur from the inside out, and you will need to place sterile gauze inside the cavity until it has healed completely. Pain in the breast and breast inflammation should subside almost immediately after aspiration or surgery.
Should You Continue To Breastfeed?
Many surgeons will advise that you stop breastfeeding, but here are some advantages of continued breastfeeding after surgery…
- Breast milk contains antibodies and healing properties that help heal the breast much quicker.
- Draining the breast can prevent pressure on the incision.
- Breast milk will help flush and clean out the wound and infected areas.
- Abrupt weaning will most likely cause more infection due to breast engorgement. You need to drain your breasts regularly, preventing infection and sore breasts.
- Don’t worry about your baby getting sick from the infection. Even if pus is visible in the milk, it is advised to continue breastfeeding; it cannot harm your baby in any way.
- If the incision was made around the nipple, where your baby would be placing their mouth while feeding, you should stop breastfeeding until the area has healed.
- Mom should express the breast milk to avoid engorgement. If the incision is too close to the nipple to express, she can let the breast dry up and continue breastfeeding on the other side alone.
How Can You Prevent a Breast Abscess?
- Breastfeeding mothers who have mastitis, engorgement, or plugged ducts should empty their breasts often.
- Use a warm compress on the breast before breastfeeding or pumping to increase the flow of the milk.
Treating Mastitis Naturally
My Cracked Nipples and Incision Had Healed Completely
"When I became pregnant, I was determined to breastfeed my baby. I educated myself as much as possible, but from the time my baby was born, I struggled to get him to latch on.
My milk finally came in on the 5th day, and by that time, my nipples were broken and bleeding. I had tender breasts, and I was terribly engorged. After a week, I developed mastitis, so I went to the doctor and received antibiotics, which helped with the flu symptoms, but not the breast swelling and the lump.
After going to the doc again, I was told I would have to go for surgery. A lump of six by six centimeters was removed, and a surgical drain was inserted into the incision. The hole of the incision had to be stuffed with gauze until it healed entirely from the inside out...so the hole got smaller and smaller as time went by.
I was advised to wear a nipple shield on the infected breast, which helped tremendously. Within a couple of weeks, my cracked nipples and incision had healed completely, and I was left with just a little breast tenderness and a small scar.
My advice to new moms planning to breastfeed is to find out as much information as possible and talk to other breastfeeding moms. Most breastfeeding problems can be defeated with support and correct information. It’s always best to get the advice of a lactation consultant instead of a doctor because most doctors will advise you to stop breastfeeding."
Even With Milk Leaking From the Wound, You Can Continue To Feed! By Louise Baker (Uk)
"I have recently finally healed from breast surgery, resulting from a breast abscess that needed draining.
I wanted to share my story as I was told, following the surgery, that I would have to stop feeding my baby boy due to milk leaking through the wound - however, this has proved to be untrue, and so other mums should be aware that they can keep going!
My breast infection turned into a breast abscess that wouldn't respond to antibiotics, so I had to have the surgery, which was not as pleasant as my abscess was huge! However, I could breastfeed after surgery as the surgeon had made the incision off the nipple. So far, so good - at least the pain was gone, and I finally felt more human again!
However, one week later, I visited the surgeon to check the wound and breast, and she found that I had milk running out through the wound. Her reaction was that I had to take tablets to stop my milk; otherwise, the wound wouldn't heal due to the constant flow!
As most breastfeeding mums can imagine, I was devastated - my little one was only eight weeks old, and I was aiming to get to 6 months at least!
After further discussion with her, there seemed no other option, but luckily we were traveling back to the UK (I was living in India at the time and had had my boy and the breast surgery out there), so she delayed the prescription and suggested I see somebody in the Uk.
We immediately arranged an appointment for the day after our return, and luckily I was met with a much more positive and pro-breastfeeding approach, which resulted in my being able to continue feeding with absolutely no problems!
My wound possibly took a little longer to heal, but ultimately it did with no problems! The milk meant that the wound was being kept clean, and I had no issue with infection, bearing in mind it's an open wound that must be packed daily.
So, for all those mums frantically googling for reassurance like I was, the message is, 'Don't stop feeding. Get second opinions and use this website!' It seems in most cases there is no need to stop."
Re: Thank You!
"Wow, thanks so much for posting your story! I have an 8-week-old and have just been through the same thing! My wound is also leaking milk, and as it is a weekend, I haven't been able to ask my surgeon if it is okay.
I felt a huge relief when I read your story!"
Re: Huge Relief
"I feel comforted when I see such stories shared.
I had an I&D done three weeks back, and now it appears I have another abscess. I am praying to God that it won't be.
I consulted another surgeon, and she suggested to stop breastfeeding altogether. I was devastated. She said that lactating mothers would get recurrent abscesses' and the only way to avoid it is to stop breastfeeding and lactation altogether by taking tablets.
I hope my I&D wounds will heal soon, and I will not have to go for another I&D."
Re: 2 months later...
"A couple of months after my surgery, and I am still breastfeeding :) my abscess was 5cm deep, and it took nearly four weeks to stop leaking milk, but I am so happy I persevered. I also thought the abscess had come back, but it was just how the wound was healing. I have had no other problems since."
My Abscess Experience: The Surgeons Were Wrong
"After a long labor and c-section, my immune system was low, and I got an infection that caused a breast abscess. My baby was two weeks old. The abscess went quickly from a red spot to requiring an incision and drainage when antibiotics didn't clear it up. The surgeon told me that sometimes milk leaks out of the wounds, and if that happened, I would have to stop breastfeeding, so I was very concerned since my baby was so young. They made a 2cm incision, and I had a hole about 1.5 cm deep.
Two days after surgery, milk started leaking from the wound. Another surgeon told me I could keep breastfeeding, but it wouldn't heal until I stopped. What? That was supposed to be two years down the road! All the midwives and LCs in the hospital said they didn't see why milk in the wound was a problem - the moisture may make it take longer to heal, but the milk would keep the wound sterile. They also said milk usually comes from these wounds because they invariably cut through milk ducts during surgery. My midwife asked an actual breast surgeon, who said milk leaking out of the wound would be fine if I didn't have a fistula. From my understanding, a fistula is when the milk duct gets blocked and creates its own path through to your skin, rather than just a duct that is cut through. (On a side note, my LC knew a woman with a fistula who breastfed with it for five months until it healed.)
After the surgery, I started feeding my baby off that breast to ensure I didn't get blocked ducts. I had a pretty big dressing near my areola, but I ensured it wouldn't block the baby's nose when feeding. I only fed for a few minutes at a time because I didn't want too much milk leaking from the wound. (In hindsight, I don't think it would have made a difference, and after a couple of weeks, I started feeding equally from both breasts.)
At night my wound would saturate my thick dressing even though it was "waterproof," and I would wake up with smelly milk all over my shirt. I was worried when it was still leaking a lot after four weeks, even though the wound was shallower and smaller. But after 4.5 weeks, it just stopped. Now, after eight weeks, there is no more hole, the skin is almost closed up, and I am still breastfeeding.
So don't let surgeons tell you that you can't breastfeed because they are wrong! It's not easy, it requires adaptations, and you may have trouble if your wound goes over your areola. I still can't pump from that breast because the pump won't suction over the dressing, so my supply is somewhat low, but my baby is still almost exclusively breastfed."
Solution for Me
"After having surgery for a breast abscess, my wound started to leak breast milk like crazy. I was constantly changing the bandages, and my surgeon told me that if I wanted to have any sense of normalcy in my life, I would need to wean so that the incision could heal properly. My daughter was only six weeks old, and I was devastated. I continued to pump for a few more weeks, and the leaking only worsened. As a last-ditch effort, my surgeon decided to put a stitch through the leaking duct as a way to damage it so it would stop producing milk. It worked! Ten months later, I am still pumping and able to give my daughter breast milk.
Not just a clogged milk duct- an abscess!
When my daughter was three weeks old, I developed what I thought was just a clogged milk duct in my left breast.
I tried home remedies to treat it, but after three days, it got worse, and finally, I saw a doctor. He prescribed antibiotics after telling me it was a breast abscess.
Somehow I had mastitis without a fever, so I didn't see a doctor immediately. I ended up being allergic to the antibiotics after taking them. That night, my face swelled up, and I had to take Benadryl. So the doctor gave me a different option the next day, but I had to pump and dump because it was unsafe for nursing. More emotional pain added to my agony!
The pain was so unbearable the following day (worse than labor!) the doctor told me to go to the ER.
I went in as soon as possible, not knowing that I would be hospitalized for four days! Being away from my daughter for the whole time was the worse part. At this point, I was in so much pain it felt like my breast was going to explode!
At first, I was told I would need a needle aspiration, but after the nurse and doctor saw the abscess using ultrasound, I had an I&D procedure done instead.
Immediately, I felt relief as it looked like a balloon deflating as the doctor pulled out 2 oz of pus.
After the 4th day, I was released to go home but still had the drainage tube connected to me for a week, a total of 10 days!
I was still on oral antibiotics for those days and was still pumping and dumping the right side not to lose my supply.
I couldn't pump the affected side right after because the skin on the nipple was so raw from the swollen lump the abscess had created. Finally, the skin died and peeled off after five days.
I had to get creative with the pumping horn that wouldn't fit over the drainage tube using a nipple shield.
At first, I only got a few drops out, but I would get a little more with each pump session. When I removed the tube, I could hand express and continued to pump.
The nurse was so helpful and advised me to continue to pump for two weeks before breastfeeding again from that side.
But out of fear, I could not nurse my daughter from either side until she was two months old. I finally overcame the fear and tried putting her back.
It was unsuccessful at first, but then I tried again, and she took me back a few times but then rejected me again. She was so used to the bottle - I didn't want to force her. I should also mention she has a tongue tie, which probably contributed to how I got the bacteria, along with other factors. I had problems latching in the beginning and had a cracked, bleeding nipple.
Now she is three months old, and I continue to pump and supplement. I now also have scar tissue that is still tender and, I believe, affected some milk ducts. It only produces half of what my right side produces, but somehow my body knows and can provide enough oz for four bottle feedings a day.
More awareness must be made known to all breastfeeding mothers and the general public! So many people don't know about breast abscesses'!
But now I am a happy mom with a happy baby, all thanks to Jehovah God and my family and friends - I was able to endure this difficult time!
I have so much more to say with more details, including different pieces of advice from different doctors. I really should write a book! But I hope this short story will help someone else too!"
I&D on a Large Breast Abscess
by Louise Baker (India)
"Hi, I have recently had to have I&D on a large breast abscess, and now I have been told, as milk is coming through the wound, I will have to stop breastfeeding altogether as the wound will not heal while this is happening! Reading your website is encouraging as it says this shouldn't be a problem, but do you have any more specific info on this issue? I do not want to end up with further problems if it doesn't heal. Many thanks from a very pro-breastfeeding mom!"
Re: Breast Milk Has Wonderful Healing and Anti-Inflammatory Properties
"Hi, Louise. Please do not stop breastfeeding. It could end up giving you even more problems if you quit!
So many doctors advise to stop breastfeeding because they do not know better - they haven't a clue about it.
Breast milk has terrific healing and anti-inflammatory properties, so it will help heal your wound faster.
Where on the breast was the incision made? If it is around the nipple where the baby has to put their mouth, then it's best to keep pumping until it heals, but if the cut is far away from the nipple, you can continue breastfeeding as normal.
Re: The Milk Ducts Are Running Directly Into the Wound
Thank you - it is good to hear this answer. The incision was made away from the nipple, as the Dr was aware I was keen to continue breastfeeding. Now she is saying that one of the milk ducts is running directly into the wound and that this will cause the wound to only heal so far - is this true? I'll be honest. I didn't ask too many questions as I was just in shock and gutted when she told me! Anyway, I am going to a different specialist for a second opinion.
I am going to fight to keep breastfeeding.
Re: Unnecessary to Stop Breastfeeding
"Hi Louise, I'm going to stick to my answer. I believe it is unnecessary to stop, but please go for a second opinion and preferably see somebody who is breastfeeding-friendly.
You know, even if you decide to stop breastfeeding from that side, you can continue to exclusively feed your baby from one breast (the breast without the cut). Many moms have done this.
Re: Unnecessary to Stop Breastfeeding
"Hi Tracy, well, it's been a bit hectic, but I wanted to update you as you'll be pleased to know that I am still breastfeeding, and the wound has finally healed! So I'm really pleased. Thank you for the support!
I visited a Dr in the Uk, and he was really good and confirmed exactly what you said about antibodies helping to fight infection, and although due to milk keeping it wet, it may take a little longer, but it isn't a reason to stop!
Re: Wonderful News!
"Hi Louise, that is fantastic news! I'm so happy for you!
I'm sure your story will help many mothers with the same issue.
Look after yourself, and thank you for the update."
Re: Hopeful to Restart Nursing After Surgery
"Your story has helped me gain the courage to start nursing again. I had a massive abscess that the surgeon drained. Although she was aware that I was nursing, the incision was made close to my nipple & I was told I had to stop nursing. It's been three weeks, I'm still having my wound packed daily, and I stopped nursing.
I regret that I didn't ask more questions as to why I had to stop nursing. I wish that I had fought more and insisted on being able to nurse by having an incision away from the nipple. I will try to get my supply back up and nurse on the unaffected side until the other side heals. Thank you for sharing & giving me hope."