Lactational infections of the breast
Lactational infections comprise about 25% of all acute infections
of the breast and are usually caused by skin commensals (e.g. Staphylococcus
aureus, Staphylococcus epidermis, streptococci). The
route of infection is usually through a defect in the skin, typically
a cracked nipple (usually as a result of breastfeeding). Most cases
occur within 6 weeks of childbirth.
Breastfeeding or milk expression should be encouraged to
effectively drain the affected area and early antibiotic therapy
implemented (e.g. oral flucloxacillin 500 mg qds or erythromycin
500 mg qds).
The development of a fluctuant mass indicates an established
abscess that should be aspirated, possibly repeatedly as long as
the overlying skin remains viable.