SAQ 317 – Obstetrics – lactational mastitis and breast abscess

Obstetrics – lactational mastitis and breast abscess.

a. Risk factors

• Incomplete breast drainage, such as poor attachment, missed feeds, long intervals between feeds, or tongue tie.
• Restrictive clothing or external breast pressure.
• Trauma to breasts or nipples.
• Engorgement, chronic oversupply, unresolved blocked ducts, abrupt weaning, poor health, fatigue, or previous mastitis.

b. Organisms

• Staphylococcus aureus, including MRSA in some settings.
• Beta-haemolytic streptococci, such as group A streptococcus.
• E. coli.

c. IV antibiotics

• First line: flucloxacillin 2 g IV every 6 hours, or cefazolin 2 g IV three times daily.
• Beta-lactam allergy: lincomycin 600 mg IV every 8 hours, or clindamycin 450 mg IV every 8 hours.

d. Image and diagnosis

• Hypoechoic rounded collection beneath the skin.
• Most likely diagnosis: breast abscess.

e. Preferred management

• Ultrasound-guided needle aspiration is preferred.
• Incision and drainage is not first-line.
• Repeat aspiration may be required, up to around three times daily.

f. Breastfeeding advice

• Continue breastfeeding from the affected side where possible.
• Reposition the baby if aspirations are performed or a drain is in situ.
• Arrange midwife or lactation consultant review to identify the trigger and reduce recurrence.