3-9
If the patient remains febrile after 72 hours:
- If possible, transfer the patient immediately. If not, then see below.
- If non-compliant, administer ceftriaxone 1 gm IM. See if the patient would also take one gram of oral
azithromycin. Follow-up in 24 hrs and repeat the ceftriaxone. - If compliant add clindamycin IV as above.
- Find an experienced person in the community who can stay with the patient and assist with breastfeeding
and manual expression.
Evacuation/Consultation Criteria: Suspicion of breast abscess, continued fever after 72 hours of antibiotics.
Breast abscess requires incision and drainage, which should be done by a trained physician if possible.
Treatment for Plugged Duct: Massage the area, gently pressing toward the nipple. Warm compresses
help. The most important intervention is frequent feeding on the affected side. Consecutive feedings should
be started on the affected side to facilitate flow from the obstruction. Because different lobes of the breast are
drained better with different nursing positions, place the infant with its chin pointing toward the blocked duct.
If the mother is separated from her infant for any reason the breast should be emptied by hand-expression
or by using an effective breast pump. Be sure to follow the mother closely as mastitis can occur. NOTE:
Plugged ducts will last only for short periods of time (a few days). Any lump that persists for many days
must be evaluated for malignancy.
Treatment for Engorgement: Frequent breastfeeding is the most effective treatment. If the nipples
are engorged it may be difficult for the baby to latch on. Relieve nipple engorgement by applying warm
compresses before the feeding, gently express some milk to soften the breast, or lean the breasts into a
large bowl of warm water (or take a warm shower) just before the feeding to facilitate milk release and soften
the nipples. After the feeding, apply cold compresses, or cool cabbage leaves to the breast for 20 minutes
leaving the nipple exposed. Use standard doses of acetaminophen and/or ibuprofen for pain relief. Use
mild narcotics in severe cases (Tylenol #3). Support the breasts with a good-fitting brassiere. Do not bind the
breasts as this will increase the engorgement.
Symptom: Breast Problems: Breast Abscess Incision and
Drainage Procedure
MAJ Ann Friedmann, MC, USAWhen: A breast abscess is causing systemic symptoms that are unresponsive to less invasive therapy. The
abscess will be a fluctuant breast mass related to non-resolving or worsening mastitis (see Mastitis section).
The condition is rare, except when antibiotic treatment has been delayed or discontinued too early. Needle
aspiration of a recurrent abscess should be attempted twice before incision and drainage is required. Do not
attempt this procedure unless evacuation to a physician is unavailable.
What You Need: Sterile prep and drape, 18 and 24-26 gauge needles, 5 cc and 10cc syringes, alcohol prep
pads, local anesthetic agent such as 1% lidocaine with epinephrine, 2x2 and 4x4 dressings, scalpel with #15
blade (but any blade will work), sterile irrigation if available, gloves, and a small Penrose drain
What To Do:
Needle Aspiration: Anesthetize skin and subcutaneous tissues over fluctuant area using 5cc syringe and
24-26 gauge needle. Insert 18 gauge needle attached to 10cc syringe into the abscess, aspirating as you
advance the needle. Drain as much pus as possible once the cavity is entered. Then remove needle and
cover puncture site with a small dressing.
Incision and Drainage of Abscess: Anesthetize the skin and subcutaneous tissues over the fluctuant mass.
If possible, choose your incision point close to but not in the areola (allow room for an infant to nurse without
contacting the incision). Make the incision parallel to the edge of the areola and over the fluctuant area. Try
not to make transverse incisions- they leave an unacceptable scar. Circumareolar incisions will heal with a