A breastfeeding woman presents with a discrete tender lump in the breast — which may be tense or fluctuant — consistent with a breast abscess. She has a known penicillin allergy, which directly constrains antibiotic choice throughout management.
This patient's penicillin allergy is central to her treatment pathway. Breast abscess is characterised by symptoms similar to mastitis, with the additional sign of a discrete tender lump, which may be tense or fluctuant. For patients allergic to penicillin, options include cephalexin or clindamycin.
The first-line approach was aspiration of the abscess collection with antibiotic cover appropriate for a penicillin-allergic patient (cephalexin or clindamycin, guided by culture and sensitivity), combined with supportive mastitis management. This protocol is indicated when inflammation of the breast has not settled within 24–48 hours of that initial treatment — the threshold for escalation.
When aspiration has not achieved resolution, a surgical approach to the abscess is the next step. Access to specialist breast clinics may be limited in some areas, particularly in rural settings, which can influence which intervention is most appropriate. The complete structured protocol — including the specific procedure, full indications, and all adjunct steps — is available via the link below.