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DESCRIPTION
Definition of an Abscess: Abscesses occur when an area of tissue becomes infected and the body is able to "wall off" the infection to keep it from spreading. White blood cells, the body's defense against some types of infection, migrate through the walls of the blood vessels into the area of the infection and collect within the damaged tissue. During this process "pus" forms, which is an accumulation of fluid, living and dead white blood cells, dead tissue, and bacteria or other foreign invaders or materials.
The breast is a modified sweat gland with multiple secretory acini that drain into lactiferous ducts. These ducts are grouped into lobules, which are demarcated by Cooper ligaments. Each of the lobule secretory ducts converge to form one ampulla, which traverses the nipple to open at the apex. When the lactiferous duct lining undergoes epidermalization, keratin production can cause plugging of the duct and result in abscess formation. This helps explain the high recurrence rate (an estimated 39-50%) of breast abscesses in patients treated with standard incision and drainage (I&D). This technique does not address the basic mechanism by which breast abscesses are thought to occur.
Postpartum mastitis (inflammation of the breast after delivery of the baby) is a localized cellulitis caused by bacterial invasion through an irritated or fissured nipple. It typically occurs after the second postpartum week and is precipitated by milk stasis.
(Note: One reason this may happen at this stage is because the nipples have not had a chance to "toughen up" yet. Breastfeeding moms often have sore, cracked and tender nipples during the first few weeks of breastfeeding and many still may be experiencing some breast engorgement until the milk volume adjusts to the baby's dietary needs. It is very important to make sure the breastfeeding mom keeps her nipples very clean and cared for between feedings to prevent cracking and possible infections.)
A BREAST ABSCESS IS: An infected area of breast tissue that becomes filled with pus when the body fights the infection. It involves breast tissue, nipple, milk glands, and milk ducts.
There are two types of breast abscesses:
1. The first is related to breastfeeding. In this case, redness, tenderness, and skin changes take place on the breast from the baby's feeding and sucking on the nipple. If mastitis (inflammation of the breast) is left untreated it may form an abscess.
2. The second type is a subareolar abscess (in the pigmented area surrounding the nipple). The second type is unrelated to breastfeeding.
FREQUENT SIGNS & SYMPTOMS
Breast pain, tenderness, redness or hardness.
Fever and chills.
A general ill feeling.
Tender lymph glands in the underarm area.
CAUSES
Engorgement, mastitis, or a plugged duct can sometimes lead to a breast abscess. (This is less likely to occur if you continue to breastfeed your baby frequently during an episode of mastitis or when you have a plugged duct or tube.) An abscess is a pus-filled area, like a boil under the skin. Your health care provider will suspect an abscess if the lump remains tender and does not go away with the treatment listed under plugged ducts and mastitis. An ultrasound of the breast may be necessary to locate an abscess deeper in the breast. An abscess often requires surgical drainage, plus antibiotic therapy.
An abscess occurs when bacteria enter the breast through the nipple (usually a cracked nipple during the early days of breast-feeding).
RISK INCREASES WITH
Postpartum pelvic infection.
Diabetes mellitus.
Rheumatic arthritis.
Use of steroid medications.
Heavy cigarette smoking.
Lumpectomy with radiation.
Silicone implants.
PREVENTIVE MEASURES
Clean the nipples and breasts thoroughly before and after nursing.
Be sure to have the baby empty both breasts during breastfeeding sessions. Keeping the milk flowing smoothly is very important. If you are having problems with breastfeeding, don't hesitate to discuss it with your midwife or lactational consultant. Don't let problems go unattended to since this may cause milk duct blockages and resulting mastitis.
Lubricate the nipples after nursing with vitamin A&D ointment or other topical medication if recommended. See recommendations below.
Avoid clothing that irritates the breasts.
Don't allow a nursing infant to chew nipples.
Be sure to continue breastfeeding your baby if you have mastitis or a plugged milk duct. If it progresses to an abscess, be sure to empty the breast with the abscess. Depending on the location and the extent of the abscess, you may or may not be able to nurse on the infected breast. Your health care provider or midwife can help you determine whether this will be possible. If you are temporarily unable to breastfeed on the infected breast, use an electric breast pump to empty the breast and nurse the baby more frequently on the other breast. Your milk volume will adjust to your baby's needs. Apply moist heat to the affected area before nursing or pumping to help the milk flow.
EXPECTED OUTCOME
Usually curable in 8 to 10 days with treatment. Draining the abscess is occasionally necessary to hasten healing. If the abscess is incised (cut to drain) it takes about 3 weeks to recover.
POSSIBLE COMPLICATIONS
It is rarely necessary to discontinue breast-feeding even with severe infection. Occasionally, certain antibiotics (especially tetracycline) and pain relievers will require that breast-feeding be discontinued for a brief period of time and it will be necessary to pump the breasts.
Rarely, a fistula (abnormal passage between two organs or between the body and the outside) may develop.
TREATMENT
GENERAL MEASURES
DIAGNOSIS
Abscesses are rare, occurring in 3-11 percent of women who have infectious mastitis. Abscesses can also develop with a recurrent plug that keeps occurring in the same spot. Abscesses can be diagnosed either by aspiration (lanced and drained with a needle by your health care provider) or by ultrasound. If you are having an ultrasound, be sure to empty your breasts as much as possible before the test so that the technicians can more easily read the results. If you have an abscess aspirated, ask your health care provider to culture the fluid that is drawn out so that an appropriate antibiotic can be prescribed.
TREATMENT
The list of treatments mentioned in various sources for Breast abscess includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
- Antibiotics.
- Penicillin.
- Surgical abscess drainage.
- Breast support.
- Breast bandaging.
- Avoid nursing from affected breast.
- Expressing breast milk from affected breast.
Breast abscess may be misdiagnosed as breast cancer or vice versa.
Use warm water (or cold water if it is more soothing) soaks to relieve pain and hasten healing.
Discontinue nursing the baby from the infected breast until it heals. Use a breast pump to express milk regularly from the infected breast until you can resume nursing on that side.
Surgery to drain the abscess (infrequent).
Abscesses can sometimes be resolved just by being aspirated, but must sometimes be surgically drained (called an incision and drainage, or I&D). An I&D can be done either under a local or a general anesthetic. It is important to request that any incision be made radially (from the chest in towards the nipple) instead of around the areola. Many breast surgeries are done around the areola for aesthetic reasons, but this cuts more milk ducts and may affect milk supply. After an I&D, the incision is left open and packed with a dressing so that it can continue to drain and heal from the outside in.
It is important to either nurse or pump the affected breast while the incision is healing to prevent engorgement, relieve pressure on the incision and help to prevent the recurrence of mastitis. As with any plug or mastitis, weaning "cold turkey" will likely complicate the problem. Some mothers are told that milk from cut ducts will leak from the incision and that they should wean immediately to prevent this. Yes, there can be some leaking at the incision (but not always), but it shouldn't be a problem, in part because of the antibodies in the breastmilk. As long as the site of the abscess does not prevent it (i.e. if it's very close to the areola or nipple), a mother should continue to nurse on or pump out the affected breast unless otherwise recommended by your health care provider. If the location of the abscess prevents direct breastfeeding, then it is recommended that you express milk from the affected breast while the incision is healing to prevent complications (even if you intend to wean from that breast after the incision is healed). If the incision is close to the nipple and it is difficult or impossible to breastfeed off the affected breast, it is possible to obtain a custom-cut pump flange to facilitate pumping when the incision is very close to the nipple. An alternative that some breastfeeding women with an incision close to the nipple have done is to let the milk dry up on the affected side while continuing to breastfeed on the normal breast.
For one mother's experience with a surgically incised abscess:
KellyMom.com: Breast Abscess
HOME CARE AFTER DRAINAGE BY INCISION:
After the abscess has been drained, take the following measures:
- If you are breast feeding, do not nurse your baby from the breast with the abscess for about 2 weeks. You may continue to nurse from the other breast. In the meantime, use a breast pump to remove milk from the infected breast. Do this as often as you normally nurse your baby, but do not feed this milk to the baby.
- You may use an electric heating pad (set on low), a heat lamp, or a warm, moist towel to help relieve pain at the incision.
- You may bathe and shower as usual. If there is a drain in the incision, wait until it is removed before washing the incision. Then you may wash the incision gently with mild, unscented soap.
- Change the dressing on the incision once a day, after bathing.
- You may restart normal activity and go back to work as soon as you feel up to it.
- Do not do strenuous exercise for 3 weeks.
Contact your health care provider if...
You notice an increase in pain, swelling, redness, drainage, or bleeding in the area of the incision.
You have a high temperature.
MEDICATION
Antibiotics, if needed to fight infection. Antibiotics, such as dicloxacillin by mouth or oxacillin given intravenously may be given.
Prescription pain medication should generally be required only for 2 to 7 days following the procedure.
ACTIVITY
After treatment, resume normal activity as soon as symptoms improve.
DIET
No special diet.
HOLISTIC & HERBAL RECOMMENDATIONS
These suggestions should be tried before a breast abscesses at the first sign of problems. Information obtained from Susun Weed's Wise Woman Herbal For The Childbearing Year:
Painful breasts have 3 main causes:1. A blocked milk duct which can cause swelling of the breast and acute pain. It usually feels like a bruised lump and a red streak or color may radiate from it.
2. Mastitis, an infection in the breast causing pain and generally accompanied by fever and acute tenderness and redness of the breast.
3. An oversupply of milk (engorgement) caused by not nursing enough or not at all. This causes swelling and soreness of the breasts that may extend up to and under the arm pits. The breasts become very hard and sensitive to touch.
POULTICES FOR SORE BREASTS
Poultices, compresses, and soaks are the best general first aid for painful breasts. Hot water alone (such as in a shower) has a beneficial effect as it stimulates circulation and eases the tension in taunt tissues. Herbs increase the effectiveness. Frequent (4-5 times a day), short (3-5 minutes), consistent applications work better than sporadic, lengthy treatments. If infection is present, throw away poulticing materials after use. If there is no infection, brews and towels may be reused a number of times.
Run a sink full of warm water and bend over it with your breasts in the sink. Allow the milk to flow out, massaging down from the back of the breasts toward the nipple in long, firm, strokes. This relieves engorgement and eases pain. This can also be done in a hot shower while bathing.
Use a hot compress of Parsley to ease swollen and painful breasts. Place a handful of fresh or dried parsley leaves on a clean cotton diaper, tie with a rubber band, and steep in simmering water for 10 to 15 minutes. Compress the breast with the hot, wet towel.
Try a hot compress of comfrey leaves, fresh or dried, to soothe sore nipples, soften engorged tissues, reduce the pain of swollen breasts, and help unblock tubes and ducts. Prepare and use like parsley.
Prepare a cold poultice of grated raw potato to draw out the heat of inflammation, localize infection, and unblock clogged duct tubes. Grate raw potato and apply directly to the breasts, covering with a clean cloth. Remove or replace when dry.
Soak breasts in slippery and slimy marshmallow root. It pleasantly soothes tender breast tissues, opens clogged ducts and tubes, powerfully draws out infection, and diminishes the pain of engorged, inflamed breasts and sore nipples. Make an infusion of the dried root, steeping 2 ounces in a half gallon of boiling water overnight. Reheat the infusion to near boiling. Pour it into a sink or basin and soak the breasts until the infusion cools.
Gently warm a handful of dried elder blossoms in just enough olive oil to cover; keep warm for 20 minutes. Strain, cool, and rub the oil into the nipples and breasts to relieve pain and sensitivity.
REMEDIES FOR BLOCKED TUBE OR DUCT
Continue nursing on a breast with a blocked or plugged tube. Cessation of nursing can increase the discomfort and endanger the milk supply. But go carefully; nurse or pump every hour but just enough to empty the breast.
Right before nursing, use any of the above warm compresses for 5 or 10 minutes.
Be sure to get plenty of rest. The blockage will usually clear within a few hours or overnight.
REMEDIES FOR MASTITIS
Treatment for mastitis with herbs should include: 1. Hot applications to the breast at least 4 times daily.
2. Plenty of bed rest.
3. Nursing as often and as long as possible on the infected breast.
Breast infections are almost always a sign of too little rest. Time to take a daily nap, and 10 minute breaks every 2 hours: Put you feet up, enjoy a cup of Violet leaf infusion; relax deeply. It is important to nurse often, keeping the breasts empty to promote prompt healing. (The breast infection won't make your baby sick.)
Poke root tincture made of the fresh root stimulates lymph gland activity and clears mastitis quickly. Poke root is potent and the effect is cumulative; use no more than 2 drops daily. Poke root can be combined with echinacea, but it may be as effective if used alone.
Propolis is a substance secreted by bees as a glue. It has a history of use against infection in Russia and a strong following among midwives in North America. It is said to accelerate healing time by increasing the body's metabolism and general resistance to disease. A dose of the tincture is 10-15 drops twice a day; it combines well with echinacea.
Elder root, dug and grated fresh into boiling water makes an excellent poultice for mastitis.
Echinacea is an excellent remedy for even severe cases of mastitis. Use 1 ounce of the root in a quart of boiling water and drink one or two cups daily for another week. If you must use the tincture, use 1/2 drop per pound of body weight in a single dose. Repeat the dose up to 6 times a day until fever remits. Continue with 2-3 doses daily for another 7 days or until all symptoms are cleared.
REMEDIES FOR ENGORGEMENT
Drink sage tea or infusion of sage. Sage is an anti-galactagogue and dries up the flow of milk.
Take 2 drops of Poke root tincture daily to decrease swelling. The same dose can be used to prevent engorgement.
REMEDIES FOR SORE, CAKED NIPPLES - PREVENTION
Expose the breasts to air. Do not wear a bra all day and all night. Wear your nursing bra with the flaps down whenever possible.
Expose the breasts to sunlight or brief periods of ultraviolet light (maximum of 3 minutes, but increase to this level very gradually.
Rub olive oil, sweet almond oil, lanolin, or comfrey root ointment into the nipples throughout the latter part of pregnancy and the beginning weeks of nursing.
Place the baby correctly, making certain that the entire areola (dark area) is in her/his mouth and that the nipple is centered.
Experiment with different nursing positions.
Nurse often so that the baby doesn't get hungry enough to tear at the breast.
Avoid washing the nipples with soap. Soap removes the natural oils and predisposes the nipple to chapping and cracking. Cologne, deodorant, and powder should also be kept away from the nipples.
REMEDIES FOR SORE NIPPLES
Apply crushed ice in a wet cloth or a wet and frozen gauze pad to the nipples immediately before nursing. Ice is a good local pain killer; it also helps to bring out soft or small nipples or the nipple of a very full breast so the baby can feed more easily.
Use comfrey root ointment to soften and strengthen nipples at the same time. Comfrey root ointments are exceptionally soothing to sensitive nipples and rapidly heal any fissures or bruises. Be sure to rinse any ointment off the areola before nursing so the baby can grasp the breast properly.
Yarrow leaf poultice or ointment totally relieves pain and heals cracked nipples rapidly.
Vitamin E helps to heal and strengthen the nipples. Apply the oil after nursing. Be sure to use only pure vitamin E, not preparations or synthetics.
Any of the poultices described for painful breasts may be used. Comfrey and marshmallow are especially effective. Several brief poultices work better than one or two lengthy sessions.
Apply the clear gel from a fresh Aloe vera leaf to soothe and heal sore and cracked nipples. Be sure to wash it off before nursing as the taste can be quite bitter.
Try homemade or commercial calendula ointment to heal and strengthen nipples.
CAUTION: Ointments containing antibiotics, steroids, and anesthetic (pain-killing) drugs are potentially harmful to you and your infant.
Breastfeeding Supplements
Information and supplements for help with breastfeeding and to help keep breasts healthy. Breastfeeding is the natural way a mother uses her milk to feed her newborn baby.
Wise Woman Herbal For The Childbearing Year By Susun S. Weed, Janice Novet
This is a complete herbal pharmacopoeia for dealing with every problem that might arise before, during and after pregnancy and childbirth. Simple, safe, remedies for pregnancy, childbirth, lactation, newborns. Includes herbs for fertility and birth control.Green Gifting Baby Care Kit , Burt's Bees
Limited Edition Gift Kit. Your little one will be giggling with delight after using the luxurious buttermilk soaps, soaks and lotions in this cute kit. This is the perfect gift for the new mom in the family or even an experience mom that still loves to pamper her little ones!Nursing Milk (Increase) Tincture, 100% Organic - 2 fl. oz.
For nursing mothers who wish to increase their volume of milk.Nursing Formula Tincture (dry up milk), 100% Organic - 2 fl. oz.
The Nursing (dry up milk) Formula was created to help dry up breast milk.Neuromins DHA (Docosahexaenoic Acid), Nature's Way 100mg - 60 Softgels
DHA is an essential fatty acid is the primary structural fatty acid in the gray matter of the brain and retina of the eye and is important for signal transmissions in the brain, eye and nervous system. DHA is taken by expecting mothers to support fetal development, and by mothers while lactating to enhance breast milk.Prenatal Vitamin with Folic Acid, 100% Natural & Complete - 180 Caps
Nature's Way Prenatal Vitamin with Folic Acid is a complete vitamin formulated to support the health of the mother and child.Blessed Thistle Tincture, 100% Organic - 2 fl. oz.
Helps nursing mothers by stimulating the mammary glands and helps to increase breast milk supply.Squaw Vine Tincture, 100% Organic - 2 fl. oz.
Squaw Vine is often used for both menstruating and pregnant women and may be used as a salve and be applied to sore nipples while nursing.Anise Tincture, 100% Organic - 2 fl. oz.
Anise herb combats infection, promotes milk production in nursing mothers, and is helpful with menopausal problems.Lanolin Oil, NOW Foods 100% Pure, Liquid - 4 fl. oz.
Pure Lanolin Oil (Liquid Lanolin) is a very high quality thick liquid and may be thinned with, Olive oil, Emo oil or cocoa butter. Pure lanolin oil can be used like petroleum jelly on chapped skin and as a moisturizer.Blessed Thistle (Cnicus benedictus) Powder - 4 oz. Bulk
Modern uses of Blessed Thistle (Cnicus benedictus) include increasing milk supply for nursing mothers, memory improvement, increasing appetite and generally preventing sickness. Four different ways of using Blessed Thistle have been recommended.Prickly Pear (Opuntia ficus indica) Herb Powder - 4 oz. Bulk
Prickly Pear is particularly useful in providing nutrients to the pancreas and liver, which support digestion and maintain blood sugar balance.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of a breast abscess.
Any of the following occur during treatment:
- Fever.
- Pain becomes unbearable.
- Infection seems to be spreading, despite treatment.
- Symptoms don't improve in 72 hours.
- New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
Click Here To Visit Herbal Remedies Product Page
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