OG17.3 | Mastitis and Breast Abscess — Summary & Reflection

KEY TAKEAWAYS

Mastitis and breast abscess represent a preventable and treatable spectrum of lactational breast disease:

• Spectrum: Milk stasis → non-infective mastitis → infective mastitis (Staph aureus, >90%) → breast abscess (pus collection).
• Presentation: Mastitis = unilateral, erythema + warmth + tenderness + fever ≥38°C + flu-like illness. Abscess = fluctuant swelling within inflamed breast; systemic illness more pronounced. Engorgement = bilateral, afebrile, days 2–5 — not mastitis.
• Pathophysiology: Poor drainage → raised intra-alveolar pressure → tight-junction disruption → cytokine release → bacterial entry via nipple fissures → suppuration.
• Diagnosis: Clinical in most cases; USS for suspected abscess (confirms collection, guides drainage); milk culture for treatment failure or MRSA suspicion.
• Management of mastitis: CONTINUE breastfeeding (therapeutic — empties breast, reduces stasis) + cloxacillin 500 mg QID × 10–14 days (or cephalexin) + ibuprofen + warm/cold compresses. Review at 48–72 h.
• Management of abscess: Needle aspiration (small, unilocular, USS-guided) OR incision and drainage (large, multilocular) + antibiotics post-drainage + continue feeding from contralateral breast.
• Failure to respond in 72 h: Request USS for occult abscess + milk culture for MRSA + review antibiotic compliance.

REFLECT

Consider the last time you saw (or might encounter) a mother on a postnatal ward with mastitis. Was breastfeeding continuation actively recommended, or was it not addressed? Reflect on why the instruction to 'stop breastfeeding' is so pervasive despite being counterproductive — what are the cultural, time-pressure, and knowledge factors that perpetuate this error? What would you do differently as the clinician in charge? Also consider: what systemic changes in postnatal ward practice would reduce the incidence of mastitis and abscess in the first place?