Breast abscess - should I go under the knife as surgeon has proposed?

[Dovemummy]

After 5 courses of antibiotics and general mismanagement of mastitis by my doctor surgery, I have now seen a consultant (general surgeon but specialising in breast and vascular) who has booked me in for excision of an abscess next wednesday. Diagnosis is of antibioma, and followed clinical exam, ultrasound and lab sample of pus (staph bacteria found). I am told my lump is too big and been there too long for needle aspiration or ?mammotene. I am terrified. Breastfeeding is finally going well after 2 months of agony and I no longer feel like I have been kicked in the chest or unwell. I am just stuck with a lump. As the crIsis is over and I have finally regained some quality of
life after a horrendous postnatal period the last thing I want to risk is an operation. I am determined to continue breastfeeding and my son is thriving now. The hospital won't allow children on wards because of swine flu and I've never been apart from my 4 month old.
Help! Does anyone have any experience of what to do in such a situation? Is there such a thing as a lactating breast specialist?

As long as you are a low anaesthetic risk, you should be a day case procedure.
Can't you express milk for the day of procedure? If you let the anaesthetist know you are BF, they will give safe drugs.
If you are desperate not to have excision- you could ask them to try needle aspiration but be prepared that it's unlikey to work...
Good luck

Thanks witch6. Got expressed milk in freezer but little one just won't take bottle, not even with me well out of the way. Surgeon said needle aspiration was a no-go as would be likely to leave some infection behind - but good suggestion and one I will pursue. It's the healing - daily packing and dressing for several days possibly weeks, too - that might also put a spanner in the works as apparenly the wound can't be sewn up as it has to heal from the inside :(

Ask the anaesthatist how long you are likely to be out for - you might find you can feed your LO before and as soon as you come round (obviously depending on how well you are feeling). I'm pretty sure the hospital has to accomodate bf mothers even with the swine flu risk around... push this point with them a bit and perhaps contact PALS at the hospital to see if they can help?

Ask for the general anaesthetic that they give for crash c sections - it comes out of the blood and bm very quickly and you will be able to feed. You may want to look on the breastfeeding network web site as they have info on drugs and bf. Push your point strongly with the hospital and they will have to accommodate you and your son as a bf dyad. Your partner will be able to do all the care aspects with the baby and you will just need to feed.

As for packing- ask about a mini-vac. Its a dressing system that basically has a vacuum pump on it causing much quicker healing of wound. Not sure if your hospital will have it and/or fund it but another avenue to think about...

Forgot to say- wound needs to be big enough for the mini-VAC to have something to suction....

I had a procedure which required me to have a general when dd was 5 months old. I fed her just before I went in and shortly after coming round. Dr said this would be fine. But you need to get the midwives at the hospital to speak to the ward and explain that you need an exception to the no child rule because you are feeding.

I am so sorry to read your post.

I was in a very similar situation over 8 years ago when virtually nobody knew about needle aspiration.

I just knew that I was not in a position to even consider an operation. (Ds2 was very ill, on IV antibiotics, dh was recovering from an operation himself...)

I went to see Professor Fentiman at Guy's Hospital in London and pleaded with him to find another solution.

After assuring me that it would not likely be successful, he reluctantly agreed to try aspiration. After 3 goes (spread across several days), it worked. I think it likely helped that the bacteria had been cultured by this point so I was at least taking the right antibiotics to fight the infection.

I also agree that if you are faced with no other option that you should ask for an exception to the no child rules since you are feeding.

Have you got a copy of The Food of Love? There is a section in there where she describes treating an absess with poulticing and narrowly avoiding surgery. I don't know if you have tried anything like that, but it can't do any harm to give it a shot.

IF you don't have a copy post back here and I will see if I can transcribe the section for you.

Wow I am touched by the helpful suggestions, thank you mums!

xMrsSx - I'll make very clear at the pre-op on Tues that I need to bfd asap after the op. PALS is good idea too.

Bert2e - is the bfdg network website on mumsnet?

witch6 - never heard of mini-vac but will ask.

BlameItOnTheBogey - I wonder if the midwives have any influence (the head of surgery doesn't seem to)?

Cadmum - really sorry to hear you went through all this. how did you manage to get a referral to Prof Fentiman?

Porcelain - unfortunately not. I had read La Leche League's the Womanly Art of Breastfeeding but there isn't a lot on abscesses/tumours in there. Not sure what poulticing is - Would be very grateful for further info if you have time.

Thank you for helping me feel a wee bit better :)

BfN article on anaesthetics is here: www.breastfeedingnetwork.org.uk/pdfs/General_anaesthetics%20and_Breastfeeding_September_2009.pdf

A poultice is basically a wet bandage, can be warm or cold, sometimes packed with herbs, or soaked in herb teas, that draws out the nastiness. If you google breast abscess and poultice you can find all kinds of "recipes", but what Kate Evans suggests (and apparently used herself) is this:

"While you are waiting for surgery it is possible that the abscess will spontaneously rupture. The pus-filled area gradually works its way to the surface and your skin will go red shiny and start to peel, keep applying hot cabbage leaves. At some point, you might find milk dripping out of your breast somewhere other than the nipple... What I did in this case was boiled some water for 20 minutes, waited for it to cool slightly and added copious amounts of salt to it. Then I soaked the affected area in bowls of hot, salt water until everything had drained out."

From my experience of poulticing other kinds of infections, I would use a large cotton wool pad in salt water, as hot as I could bear, pressed to the area for about 10 minutes at a time, (then dried to avoid irritating the skin), frequently throughout the day. If using cabbage I would pack the hot leaves (Kate doesn't suggest how to heat them, but I would expect they would be steamed to be hot, but not cooked!) under a warm cotton wool pad or dressing.

If you have an abscess that is too large to safely aspirate then you have an area of pus inside the breast that has formed a wall around itself which means that antibiotics will not be able to penetrate it properly to kill the bugs. If it is not drained (either by aspiration if small enough, popping spotaneously or open drainage) then it is highly likely that you will become ill again with a high temperate and even eventually blood poisoning. It is a very dangerous thing to have and will not just go away on its own unless it pops, at which point you would need the same dressings as if it had been opened sugically because there would still be a hole that needed to heal from the bottom up to avoid a pocket being left that would just fill up with pus again.

As people have said there are anaesthetics that are safe for breastfeeding mothers, there are anti-biotics that are safe for breastfeeding mothers (in fact most are, although not all) and there are painkillers that are safe for breastfeedng mothers. In most cases an I&D (incision and drainage) would be done as a day case, so you would be able to get home asap and most hospitals would make an exception for a fully breastfed baby. If they were trying not to, and some members of staff are not very aware so might, then most hospitals nowadays are trying to get baby-friendly status or have it so will have a MW breast-feeding coordinator who may not be brill at actual BFing help but will stand up for you about your babe being allowed on the ward.

Don't panic, it is a relatively small operation but a very important one if you need it.

Dovemummy, Without boring you with the details, my case was also badly mismanaged by the local GP's surgery so when I asked for a referral they obliged. (I was given Professor Fentiman's name from a mum at the NCT.)

Everything that wrigglerstea is saying is true but I want to point out that in my case I did not get ill again presumably because the pus was cultured and I was taking the right antibiotics when the abscess was aspirated.

When I was in your position, I spent hours on the internet and on the phone with experts from Canada (home for me), the UK and Ireland. They were all convinced that the operation was the only option but I simply could not accept this as it would have been very difficult for my family.

I got the impression that the consultant only attempted the aspiration to humour me but it did work.

I had the same problem 5 1/2 years ago now. I was put on an emergency list, the way the Dr explained it to me is that the cyst bursts, it can get into your blood stream and posion you. Please have the op. The packing of the wound (which went on for 8 weeks) was fine, not at all painfull. By the way, if the incison is on the top of your breast, it will not need packing as gravity will help to heal quicker (I know 'cos my wound was packed every day for 8 weeks post op, and when I had my consultant follow up at 8 weeks, my consutant went mad - turned out the Doc had written my discharge summary wrong!)
Just get the op over with before you do start to feel ill, 'cos you will, DH will have to manage. ALso, im sure baby would rather have formula milk and a healthy mummy.
Oh, & 5 1/2 years, the scar is fine, a very faint silvery scar on the edge of my nipple. Can hardly see it.

PS) I also had the pus "needle aspiratied" once a week for 3 weeks before I needed an emergency op..

Am so grateful for words of wisdom and hearing different perspectives. It is such a muddle. Unfortunately feeling a bit poorly today and breast red and lump seems to have grown slightly after seeming to have been getting better for about a month (I think ironically the worsening is due to pre-potential-surgery stress). Word of warning for other ladies - I started feeling extra tired a couple of days ago and noticed lumps on the back of my tongue around the same time: I feel intuitively that the body has to be very well to spontaneously fight off a severe infection. I have given it a really good shot but with a little bubba I just don't think the optimal resting and self-care conditions can be reached. Now thinking that the op has got to happen. Really gutted. Feeling too exhausted now to push for aspiration. Planned op seems path of least resistance. I hope I won't live to regret it. Hearing your experience KayM makes me think that I shouldn't take a chance any longer. Really sorry to hear what you went through. Wrigglerstea - I think a distinguishing feature of an antibioma as I've been diagnosed with is that there is a definite wall around the pus (that incorrectly prescribed antiobiotics help build). Porcelain - at least I will now have an idea of what to do if it ruptures before Wednesday! Cadmum - I think the hospital appointed an infant feeding co-ordinator shortly after ds was born. Will try and pursue on Monday with PALS. Can't believe how breastfeeding unfriendly the health service is :(

Had a breast abcess lanced about eight weeks ago. Was in at 7am, all over by 10am and out by 3pm. Wound was packed for one day then left open under a waterproof breathable bandage for about a week. The relief was immediate and eight weeks later I am left with a very small scar which gets smaller by the day.

Have to say that from my discussions with my surgeon (admittedly a private surgeon here in Dubai) that I would definitely not try a poultice. His opionion was that if left to burst open on it's own the wound would be "ragged" and therefore be more difficult to heal and leave a much more prominent scar. Happy to answer any questions if you would like to pm me.

It is good to hear of a positive surgical experience (I am just drying away tears as the reality of having to say bye-bye to my dear little boy for the general anaesthetic and not being there for him when he cries has hit me hard). When you say lanced, do you mean cut out (i.e. breast opened up) or drained with a needle? Did you / are you breastfeeding and if so, how did you cope?

Oh, Dovemummy... I am sorry that you are crying. I can really relate to your pain and frustration.

You sound like a lovely mum. I really do hope that you can summon the courage to insist that he be able to feed as soon as you feel able following your op.

Has your surgeon discussed the incision and the packing with you? Does he understand that it is your desire to continue breast feeding?

Im surprised that they wont allow your bub in as a border but id also suspect it will be a day procedure? Just in reagrd to a commen t above about a different type of anaesthetic? as someone who works in anaesthetics.. we use the same drugs for pretty much everyone, in routine surgical cases. The only difference in an emergency is how we would intubate someone, known as a rapid sequence in an emergency and this doesnt change the time in which you could feed bub. Id suspect the procedure could be done under local if you were happy with that?

Sorry - didn't explain myself too well. I had it opened under general and it was FINE.

I was breastfeeding (I have to say I gave up afterwards tho - I was generally exhausted - I have no support network/family here and I really can't risk getting sick with mastitis AGAIN) and I expressed a lot the day before. I did also leave some formula with Dad just in case, but it wasn't needed. I can appreciate how hard it must be leaving him but honestly (please don't think me mean!) in the end I actually ENJOYED my day. I got loads of sleep, the nurses were lovely, I had loads of cups of tea brought to me and I went home refreshed and with a boob that no longer felt like it would explode. It was like a new start IYSWIM?

Sending you lots of positive vibes across the miles! xx

Oh and in the days that followed I expressed from the operative boob and fed from the other. Again it was fine! x

Cadmum - ahh that's kind. Surgeon knows about bfdg and I understand it is important to drain the milk to prevent even more engorgememt. I need to check it will be him actually doing the op. He has told me about incision and packing although KayM says she had this done unnecessarily so I think I need to double check on that.
Chloeb2002 - day case all being well although I could be separated from bubba for quite a few hours and miss a number of feeds. Surgeon was very clear local anaesthetic was no-go because it wouldn't be enough coverage/pain relief required.
dubaipieeye - very encouraging story! I can so relate to what you say about breastfeeding. I am going to keep going but agree there has to be a limit to the pain and suffering. And thank you, it does help to not feel alone about this.

Best of luck Dovemummy, please let us know how you get on.