Written by Dr.M.D.Mazumdar, MD
A breast abscess is caused by infection of the engorged glandular system of the breasts. Around 1 woman in 10 who are breastfeeding suffer from engorgement of the breasts. Of these, around 3 in 100 develop mastitis in spite of being on antibiotics.
Mastitis means an inflammation of the breast tissue. In its more serious form, there may be a single pocket or multiple pockets of pus in the breast tissue - this is then called a breast abscess.
The breasts are composed of 20 lobules surrounded by pockets of fat. These lobules produce milk from the mother's blood after the delivery of the baby.
But from about 3 -4 days after delivery, the amount of milk secreted increases. If the milk is not removed by the baby by suckling and it stagnates inside the breasts, breast engorgement can occur. This stagnant milk is a rich media for the growth of bacteria, leading to the development of mastitis and breast abscess.
Infection in breast abscess is usually caused by a bacteria known as staphylococcus aureus. It enters the breast from an infected cracked nipple, either from the nasopharynx of an infected baby or more commonly, from the infected hands of nurses, midwives, doctors or the mother herself.
Signs and Symptoms of Breast Abscess
- Fever : The patient may complain of fever accompanied by severe chills and rigor. The body temperature may be very high, even up to 105 degrees F.
- Painful lump in the Breast: Since the breast abscess occurs predominantly in one of the glandular systems, (each breast has twenty glandular system), one part of the breast shows a red, hard, tender area. The skin over the area is indurated and thickened. The surrounding skin is red and shiny and may show engorged blue veins running over it.
If the abscess is not treated immediately, there is breakdown of the tissues involved in the abscess. There is collection of pus under the skin and the area becomes soft and fluctuant.
Sometimes the breast abscess may burst spontaneously and pus may be seen dribbling from an open pus point on the abscess. Bursting of the abscess, whether spontaneous or surgical, causes a reduction of the intensity of the pain.
Sometimes the only symptom may be a soft tender lump on the breast. The lump does not diminish in size after breastfeeding. On pressure, soft fluctuating pus will be felt - pressure will cause intense pain.
- Severe Pain: There is usually severe pain over the site of the abscess. The pain is constant and throbbing in nature. Touching or applying pressure on the red and inflamed skin causes a flare up of the pain. Pain can also occur on movement of the entire breast.
- Nipple Discharge: Pus may dribble form the nipple, especially when pressure in applied on the breast. Nipple discharge occurs only when the abscess is connected to the ducts opening on the tip of the nipple. The pus is creamish or greenish in color, thick and foul smelling.
- The axillary (armpit) lymph nodes may also get inflamed, red and tender.
When to Contact the Doctor
- Painful lump on the breast.
- Persistent fever of more than 101.5 degree F (38.6 degree C) .
- Nausea and vomiting.
- Chills and rigor (spontaneous trembling of the body) together with fever.
- Pus draining from the nipple.
- Red streaks extending from a particular painful point on the breast.
- Painful lump in the armpit.
Management / Treatment of Breast Abscess
- Surgery: The pus of the abscess should be drained out by a deep radial incision parallel to the lactiferous duct. The incision should be made very carefully so that the other lobular systems are not touched.
- Medicines: Proper antibiotics and analgesics are given to control pain and inflammation.
- Support: The breasts should be supported with proper brassieres. Well fitting nursing bras without wires should be used for proper support of the breasts. Wires in the bra can prevent proper drainage of the pus.
- Breast Pump: The milk on the affected side should be drained out by a breast pump.
- Breast feeding Breast feeding should be stopped on the affected side till the condition is cured. However, feeding may be continued on the healthy side. Feeding can be restarted on the affected side after healing of the abscess.
- Clean vaginal pads must be used and changed frequently to prevent spread of infection.
- Normal Vaginal Discharge without Itching.
- Sore Breasts in Pregnancy.
- Stretch Marks .
- Different Sexually transmitted diseases - Herpes, HIV, Chlamydia etc..