A Few Words About Mastitis and Breast Abscess

 Dr.Jack Newman
It has been known for many years that it is better to continue breastfeeding, even on the side of the infection, when a mother has mastitis. For one thing, continued breastfeeding on the side which has the mastitis, will decrease the pressure in the breast and relieve some of the mother’s pain. Furthermore, it has been a long accepted principle of the treatment of infections that the area infected should be drained as best possible so that blood with immune substances are able to get to the area of the infection and help fight off the infection.
The argument that the baby might get the infection from the milk does not stand up to scrutiny. First of all, mothers and babies share germs and if the mother gets mastitis, usually caused by Staphylococcus aureus, the baby has already been exposed to the infection, before the mother got mastitis. Bacteria don’t suddenly appear out of the blue and immediately cause infection. It takes time, at least a few days, and the whole time, the mother and the baby are sharing this germ. In fact, mothers have often been colonized with the bacteria for weeks or months even before the baby was born. Even if the bacterium causing the mastitis is MRSA (methicillin resistant Staphylococcus aureus), this does not mean the mother should stop breastfeeding. The fact of the matter is that the immune protection a baby gets from breastfeeding is not theoretical, it’s real and taking the baby off the breast will only increase his chances of getting sick and more severely sick than if he remained breastfeeding, even on the side of the infected breast.

I find it difficult to accept that a mother can have mastitis without having a painful lump in the breast. Too often mastitis is diagnosed when a breastfeeding mother has any pain in the breast and there are several other possibilities for this pain without a lump.

I have dealt with the question of antibiotics in a recent post. I will just point out again that the antibiotics used for mastitis (or almost any infection) do not require the mother to interrupt breastfeeding.

The typical course of mastitis is improvement over 24 to 48 hours (fever starting to resolve, less pain) and the lump decreasing in size over the first week or so, with, usually, complete resolution in 7 to 14 days. If the course of events, with or without antibiotics, does not follow this guideline (and it’s a guideline only), especially if the lump does not get smaller with time, one must consider that the mother has an abscess or a cyst. With regard to a cyst, one needs only make the diagnosis. I do so by aspirating the lump. If it’s a cyst, the lump will contain milk or a milk-like liquid.

However if the lump contains pus, it is an abscess.
The first thing to say about a breast abscess is that it’s not as bad as many think. It means the mother’s body has partially but not completely successfully fought off the infection. The infection is not cured, but it is walled off and the mother’s body has prevented the infection from spreading to other parts of the body.

Too often a mother with an abscess is referred to a surgeon, too many of whom will tell the mother she must stop breastfeeding. The other issue is that the surgeon will drain the abscess using an incision around the areola. The problem with that type of incision is that the mother cannot put the baby back to the breast because of the pain and secondly that type of incision, even partial, may compromise milk production, not only for this baby but for any babies born later.

For the past 10 years at least, we have referred mothers with abscesses to intervention radiologists instead of surgeons. By using ultrasound to locate the abscess and then putting in a small drain, far from the nipple and areola, none of over 100 mothers we have seen with abscesses were told to stop breastfeeding (one decided to stop even though no-one advised her to stop), one developed a recurrence which was treated successfully the same way and one had persistent leaking from the site of the catheter but after 3 weeks it healed without her stopping breastfeeding even on the side of the abscess. If anyone wants an article that describes this method, please email me at drjacknewman@sympatico.ca.