Breast Abscess Not Settling After Aspiration: Next-Line Management in Breastfeeding Women
This protocol covers management of a lactational breast abscess — a discrete, tender lump in the breast, which may be tense or fluctuant — in a breastfeeding woman who is not allergic to penicillin, when initial aspiration-based treatment has not produced the expected response.
Clinical scenario: A breastfeeding woman presents with a breast abscess: a localised, painful lump in the breast that may be tense or fluctuant, arising as a complication of mastitis that was rapidly progressive or not managed expeditiously. She has no penicillin allergy.
When does this protocol apply? First-line treatment — aspiration of the abscess collection with antibiotic cover — has been attempted, but inflammation of the breast has not settled within 24–48 hours, the threshold that triggers escalation to the next management step.
Next-line approach: When aspiration has not been effective, or where aspiration is unavailable, a surgical approach to the abscess collection is the next step — an option that may be particularly relevant where access to specialist breast services is limited. The complete structured regimen is available via the link below.
References
A breast abscess, a localised collection in the breast tissue that results in a painful breast lump, is potentially secondary to bacterial mastitis that is rapidly progressive or is not managed expeditiously.
Breast abscess is characterised by symptoms similar to mastitis, with the additional sign of a discrete tender lump, which may be tense or fluctuant.
Incision and drainage if not settling or aspiration is unavailable.
Access to specialist breast clinics may be limited in some areas, particularly in rural areas, so surgical incision and drainage may be the treatment of choice in this setting.
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