Tuesday, February 21, 2012

Breast Abscess,a Gynaecological perspective

I am writing this post on Dr Shalabh Mohan i.e, my husband's suggestion.It happens not infrequently when one of my postnatal patients contacts me when a mastitis has already turned into a breast abscess.I promptly refer them to Shalabh ,not just because of my relationship with him but because he surely is one of the finest surgeon I have come across.

His treatment for Breast abscess is Incision and drainage.The incision can be circumferential or radial as the situation demands.He prefers that breast secretion should be stopped from the operated breast to prevent fistula andto help proper healing.Now Ipsilateral suppression of breast milk is impossible which simply means writing cabergoline for an anxious and emotional mother who doesn't want to stop feeding her few week old baby

.Now this is the point where he wished me to check what our books or literature has to say.
In fact there was no clarity on suppression of milk production.One study in Turkey ( I actually don't know the size of it) found that needle aspiration of pus under ultrasound guidance gave same results as I and D.It is also mentioned that milk shouldn't be fed from the affected breast.But none of my books commented whether that means suppression or not.So,Dr Shalabh you can carry on with what your surgical books have to say.

Mastitis is the precursor of abscess ,and it can be easily controlled by antibiotics.Initially there is some inflammation in nipple and areola which causes obstruction in milk flow.An obstructed milk duct gets infected and causes mastitis.If proper antibiotic coverage isn't given at this time it leads to abscess.At this stage breast feeding should not be stopped from the affected breast ,as it is supposed that feeding helps in clearing of infection from the affected ducts.
Finally.........I think I am not very good at counselling Ladies regarding Breast feeding.UNICEF as come out with 10 steps which helps in minimizing the problems related to breast feeding and to make it a pleasant experience for mother and baby both.Will go through it and let me see if that helps!!

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