Breastfeeding with a breast abscess

Can I breastfeed with a breast abscess?

Mothers with an abscess are encouraged to continue breastfeeding at least with the healthy breast and with both if possible. If it is not too painful, breastfeeding should continue on the abscessed side as long as the baby is not in direct contact with pus or infected tissue and is willing and able to breastfeed. Babies who are reluctant to feed on the abscessed breast should be offered that side first. If it stops making milk, mothers can continue to breastfeed with the healthy breast. If the abscessed breast continues to make milk but the baby cannot breastfeed, mothers need to empty it by expressing to help the abscess settle and prevent further pain and swelling. The milk can be given to the baby as long as it has not touched pus or infected tissue. Mothers need to ensure that their baby is taking in enough milk and supplement the baby if not. If mothers decide to stop breastfeeding on one or both breasts, it needs to be done safely.

A) Breastfeeding on the healthy side

Mothers with an abscess in one breast can continue to breastfeed with the other breast. This may provide some or all of a baby’s milk.

Treatment for an abscess usually includes antibiotics. Nearly all antibiotics used to treat breast abscesses and mastitis are compatible (pose little or no risk to the baby) with breastfeeding.

Mothers who have surgery, especially breast surgery, need additional practical and emotional support to help look after themselves and their baby.

B) Breastfeeding on the abscessed side

A smaller breast abscess (outlined in black). The abscess was treated with needle aspiration and the mother continued to breastfeed without problems on both breasts.

Continuing to remove milk from the breast is an important part of the treatment of mastitis and most abscesses (Amir 2014). The best way to do this is to breastfeed. Expressing may be less effective.

Mothers can breastfeed:

  • As long as the baby is not in direct contact with pus or infected tissue (Amir 2014).
  • If the baby is able and willing to breastfeed.
  • If the mother is not in too much pain.

Breastfeeding with an abscess is similar to breastfeeding with mastitis.

If the baby is becoming reluctant to feed on the abscessed side, we recommend that mothers start all feeds on that side. Babies are most likely to breastfeed normally if the abscess is smaller and well away from the nipple.

Mothers can also use the relevant general care recommendations for mastitis.  

C) Expressing on the abscessed side

1) Reasons for expressing

Some mothers choose to continue breastfeeding on the normal side and express the abscessed side as they:

  • Do not wish to breastfeed on the abscessed side.
  • Are forced to stop breastfeeding temporarily on the abscessed side because:
    • It is not safe for the baby.
    • They are in too much pain.

As long as the expressed milk is not in contact with pus or infected tissue, it can be given to the baby.

2) Effective expressing

Expressing is less effective than breastfeeding at removing milk; expressing with a breast abscess even less so. However, effective milk removal is important as stagnant milk can cause more swelling and slow down healing. The pain and swelling can impair the let-down and interfere with milk removal.

To express more effectively, mothers can:

3) Resuming breastfeeding after expressing

Some mothers may wish to resume breastfeeding once the abscess has improved or healed. They should return the baby to the breast as soon as possible. However, resuming breastfeeding on the abscessed side may be difficult, because the milk supply may be reduced by:

The baby may reject the breast because:

  • It is no longer familiar.
  • The milk supply is reduced.
  • The nipple has been pulled into the breast.

D) When an abscessed breast stops making milk

A breast abscess under the nipple. There is a hard mass that extends from under the nipple to about 1 cm (1/2 inch) behind the areola (see black mark). This breast is no longer producing milk and the baby cannot latch.

If the abscess is behind the nipple or close to it or involves the whole breast, mothers may not be able to breastfeed on that side because:

Mothers can use a pinch test to see if their nipple root is hard or the nipple is pulled into the breast. If so, the usual treatment of massage is unlikely to soften the area enough or at all.

In this situation, mothers may not be able to express any milk or they may only obtain a few drops. Rather, the swelling is preventing milk from leaving the breast and the breast will dry up. It is very difficult to increase the milk supply (re-lactate) in this situation. The breast may not make more milk until the next pregnancy.

It is unlikely that the baby will ever resume breastfeeding on this side. The mother would be able to continue breastfeeding on the normal side.

E) Drying up

Some mothers may choose to allow the abscessed breast to dry up or to stop breastfeeding completely (wean).

It is safest to breastfeed or if not possible, to express until at least two weeks after the abscess has cleared. This helps the abscess heal faster, avoids further pain from breast fullness, and makes a recurrence less likely. They need to ensure that weaning is safe for themselves and their baby.

F) Monitoring the baby’s growth

Breast abscesses can temporarily or permanently decrease the milk supply.

Mothers need to make sure the baby is getting enough milk. If the baby shows signs of being underfed, the baby needs to be supplemented with appropriate milk.

If the milk supply is reduced or stopped on the abscessed breast, it is not uncommon for the healthy breast to quickly increase milk production. We have worked with many mothers in this situation whose babies did not need any supplementing. Indeed, we have found the healthy breast has a remarkable ability to increase the amount of milk it makes.

G) Breastfeeding and milk supply after the abscess is healed

1) The current baby

Mothers who have continued to breastfeed on both breasts throughout abscess treatment, who had an abscess that was located away from the nipple, and whose babies did not need supplementing should be able to continue breastfeeding on both breasts without problems once it is healed.

Milk supply in the breast that had the abscess is more likely to stay low if:

  • The abscess is big and involves most of the breast.
  • The abscess is close to the nipple.
  • The baby has not been breastfeeding and mothers are unable to express any milk.
  • There is more than one abscess.
  • The mother has had abscess surgery instead of needle aspiration.
  • Mothers had packing (gauze) put into the wound after surgery.

Babies may react to the low supply by being reluctant to feed on the healed breast. This may improve or the baby may start to reject the breast completely.

2) Future babies

If the current baby does not need milk supplements, the mother will most likely have a normal milk supply with the next baby.

If the current baby needs large amounts of milk supplements, there is a greater chance the breast has been permanently damaged. The next baby must be watched closely in the early days to make sure they are getting enough milk.

References

Amir LK. Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #4: Mastitis, revised March 2014. Breastfeeding Med. 2014;9(5):239-43