Breast-feeding and infections...

Breast infections most commonly affected women from 18-50 years. They can be divided into infections related to breast-feeding and those that are not (non-lactational abscesses). It is important to treat any infection of the breast early and correctly to ensure they do not develop into deeper problems. As with all diseases of the breast it is also important to make sure a cancer is not missed.

Lactational breast abscess

This is a localised infection in the skin and tissue of the breast that is caused by bacteria which can enter the breast through a cracked nipple or fissure. It commonly occurs in the second to fifth week of breast feeding when a mother is still getting used to the whole procedure. Unsatisfactory breast feeding may cause milk retention and stasis which can make the problem worse. The breast becomes hard and swollen, completely or in one area, and it is painful to breast feed of even touch the breast. When the breast is swollen like this it is called mastitis. This can be adequately treated with antibiotics. During this phase frequent expression of milk will help prevent stasis and progressive infection. Cabbage leaves kept cold in the fridge also provide relief from the discomfort.

Milk must be expressed from the infected breast (the one with the abscess) that is involved in the inflammatory process and the baby can continue to feed from the other breast. If the mother wants to stop breast feeding, lactation can be suppressed with fluid restriction and medications.

As the infection develops, if untreated it can form a collection of pus which causes even more pain and sometimes a bulge in the breast. This pus will not resolve on antibiotics and needs to be drained. The current recommended treatment is high dose antibiotics (Co-amoxyclav is the drug of choice and safe in breastfeeding mothers) as well as repeated ultrasound guided aspiration (we seldom have to carry out a surgical incision and drainage procedure nowadays).

Thrush

Thrush can also affect the lactating breast, causing burning, shooting pains during breastfeeding and causing sore patches on the nipples (and a paler areola). The difficulty with thrush is that it can be passed from the baby’s mouth to the mother’s breast (causing the infection in the first place), and as the mother feeds the baby, it can be passed back again. It is very important to the mother and her baby at the same time, for long enough to ensure all infection is gone. Thrush can be treated with Fluconazole (diflucan) tablets and an anti-fungal cream for the nipples.