From the Research
After being treated with oral antibiotics for mastitis, you should seek medical attention for possible abscess drainage if you notice a persistent firm, painful lump in your breast that doesn't improve after 48-72 hours of antibiotic treatment. Other concerning signs include worsening pain, increased swelling, fluctuance (a soft, fluid-filled feeling under the skin), skin discoloration, fever that doesn't resolve, or pus drainage from the breast. Antibiotics alone cannot effectively treat a formed abscess because the medication cannot adequately penetrate the walled-off collection of pus. Drainage is typically performed by a healthcare provider using a needle aspiration or surgical incision, often with ultrasound guidance. The procedure is usually done with local anesthesia and provides immediate pain relief. After drainage, you'll likely continue antibiotics (commonly dicloxacillin 500mg four times daily or cephalexin 500mg four times daily for 7-10 days) to clear the remaining infection 1, 2, 3. If you're breastfeeding, you should continue to empty the affected breast regularly through nursing or pumping, as this helps healing and prevents milk stasis that could worsen the infection 4, 5. It's essential to note that the effectiveness of antibiotic therapy for lactational mastitis is still uncertain, and high-quality studies are needed to determine the best course of treatment 2, 3. However, current evidence suggests that antibiotics can help alleviate symptoms, and drainage is necessary for abscesses that do not respond to antibiotic treatment alone 5.
Key Points to Consider
- Persistent firm, painful lump in the breast after 48-72 hours of antibiotic treatment
- Worsening pain, increased swelling, fluctuance, skin discoloration, fever, or pus drainage
- Importance of drainage for abscesses that do not respond to antibiotics
- Continued breastfeeding and emptying of the affected breast to promote healing and prevent milk stasis
- Uncertainty surrounding the effectiveness of antibiotic therapy for lactational mastitis and the need for high-quality studies 4, 2, 3
Management and Treatment
- Seek medical attention for possible abscess drainage if symptoms persist or worsen
- Drainage performed by a healthcare provider using needle aspiration or surgical incision with ultrasound guidance
- Continued antibiotic treatment after drainage to clear the remaining infection
- Regular emptying of the affected breast through nursing or pumping to promote healing and prevent milk stasis 1, 5