Breast Abscess While Breastfeeding: Symptoms, Treatment & Recovery

What Are the Symptoms of a Breast Abscess?

The main symptoms of a breast abscess include intense localized pain in a specific area of the breast, redness or skin discoloration, swelling and tenderness, fever, and feeling generally unwell. The affected area may feel fluctuant (soft and movable) when touched, indicating a collection of fluid. Unlike mastitis where pain is more diffuse, abscess pain is typically concentrated in one distinct area.

Breast abscess symptoms often develop gradually over several days, typically following or occurring alongside mastitis. However, in some cases, symptoms can appear suddenly and progress rapidly. It is important to recognize these symptoms early so that you can seek appropriate medical care before the condition worsens.

The localized nature of breast abscess symptoms helps distinguish it from mastitis, where inflammation tends to affect a broader area of the breast. With an abscess, you will typically notice that the most intense symptoms are concentrated in one specific spot, which represents where the collection of pus has formed.

Most women with a breast abscess only experience symptoms in one breast, making it easier to identify that something is wrong. The combination of local symptoms and systemic signs like fever and fatigue indicates that your body is fighting a significant infection that requires medical attention.

Common breast abscess symptoms

The following symptoms are characteristic of a breast abscess during breastfeeding. You may experience some or all of these symptoms, and their severity can vary:

• Intense localized pain: Severe, throbbing pain concentrated in a specific area of the breast, often worse than mastitis pain
• Redness or discoloration: A distinct area of red, pink, or darkened skin overlying the abscess, which may appear shiny or stretched
• Swelling and tenderness: The affected area feels swollen, warm to touch, and extremely tender when pressed
• Fluctuant mass: A soft, movable lump that feels like it contains fluid when pressed - this is a key sign of abscess
• Fever and chills: Body temperature above 38°C (100.4°F), often accompanied by shivering and sweating
• Feeling unwell: General malaise, fatigue, body aches, and feeling "under the weather"
• Reduced milk production: Less milk or no milk coming from the affected breast
• Nipple deviation: The nipple may appear slightly turned or pulled toward the abscess location
• Skin changes: The skin over the abscess may become flaky or start to peel

When symptoms indicate an emergency

While most breast abscesses can be treated on an outpatient basis, certain symptoms indicate that you need immediate medical attention. These warning signs suggest that the infection may be spreading or becoming more severe, which requires urgent intervention.

High fever that does not respond to fever-reducing medications, rapidly spreading redness extending beyond the breast, or severe symptoms that are worsening despite treatment all warrant emergency evaluation. Similarly, if you develop signs of sepsis such as rapid heartbeat, confusion, or difficulty breathing, seek immediate medical care.

What Causes a Breast Abscess During Breastfeeding?

Breast abscesses during breastfeeding are caused by bacteria, most commonly Staphylococcus aureus, entering the breast tissue through cracked, damaged, or sore nipples. The bacteria multiply and cause an infection that may initially present as mastitis. If mastitis is not adequately treated, pus accumulates in the infected area, forming an abscess. The first two months postpartum carry the highest risk.

Understanding how breast abscesses develop helps explain why prevention and early treatment of nipple damage and mastitis are so important. The process typically begins with damage to the nipple, which creates an entry point for bacteria that normally live on the skin. Once inside the breast tissue, these bacteria can multiply and trigger an inflammatory response.

The body attempts to fight off the bacterial infection by sending white blood cells to the affected area. These immune cells, along with the bacteria they destroy, accumulate and form pus. If this process continues without effective treatment, the pus collection grows larger and forms a distinct pocket - the abscess. The abscess cavity becomes walled off from surrounding tissue, which is why antibiotics alone cannot resolve it - the medication cannot penetrate effectively into the enclosed pus collection.

Several factors can increase the likelihood of developing a breast abscess. Understanding these risk factors can help you take preventive measures and recognize when you might be at higher risk, allowing for earlier intervention if problems develop.

Risk factors for breast abscess

While any breastfeeding mother can develop a breast abscess, certain factors increase the risk. Being aware of these risk factors allows you to be more vigilant about prevention and seeking early care for breast problems:

• Cracked or sore nipples: Damaged nipple tissue provides an entry point for bacteria and is the most common predisposing factor
• Previous mastitis: Women who have had mastitis, especially if inadequately treated, are at higher risk of abscess formation
• First-time breastfeeding: New mothers may have more difficulty with proper latch and positioning, leading to nipple damage
• Early postpartum period: Most breast abscesses occur in the first two months after delivery
• Incomplete breast emptying: Milk stasis can contribute to bacterial overgrowth and infection
• Smoking: Tobacco use is associated with increased risk of breast abscess
• Diabetes: Women with diabetes may be more susceptible to infections
• Obesity: Higher body weight is associated with increased risk of breast infections

How bacteria cause abscess formation

The most common bacterium responsible for breast abscesses is Staphylococcus aureus, including methicillin-resistant strains (MRSA). Other bacteria that can cause breast abscesses include Streptococcus species and anaerobic bacteria. The type of bacterium involved may influence treatment choices, which is why healthcare providers often take a sample of the pus for bacterial culture.

Once bacteria enter through damaged nipple tissue, they begin to multiply in the warm, nutrient-rich environment of the breast. The body's immune response creates inflammation, which causes the characteristic redness, warmth, swelling, and pain. As the infection continues, dead tissue, white blood cells, and bacteria accumulate to form pus. This pus collection becomes enclosed in a fibrous wall, creating the abscess cavity.

When Should You See a Doctor for Breast Pain While Breastfeeding?

Seek medical care promptly if you experience intense localized breast pain, a distinct area of redness or hardness that does not improve with 24 hours of home treatment, fever above 38°C (100.4°F), or symptoms that worsen despite antibiotics. Seek immediate care for a fluctuant (soft, movable) lump, rapidly spreading redness, or symptoms of sepsis such as confusion, rapid heartbeat, or difficulty breathing.

Knowing when to seek medical care is crucial for preventing complications and ensuring prompt treatment. While minor breast discomfort is common during breastfeeding, certain symptoms warrant professional evaluation. Early intervention can prevent mastitis from progressing to abscess and ensure that abscesses are treated before they become larger or more complicated.

Many breastfeeding problems can be managed at home with proper technique, frequent feeding, and supportive measures. However, when symptoms suggest infection or abscess formation, self-treatment is not sufficient. Healthcare providers have the tools and expertise to accurately diagnose the problem and provide appropriate treatment, including drainage if an abscess has formed.

Do not delay seeking care because you are worried about interrupting breastfeeding or because you hope symptoms will resolve on their own. Prompt treatment actually makes it more likely that you will be able to continue breastfeeding successfully, while delayed treatment can lead to more severe complications that may affect your breastfeeding journey.

Signs you should contact your healthcare provider

Contact your doctor, midwife, or a breastfeeding clinic if you experience any of the following symptoms. These signs suggest that you may have an infection that requires medical treatment:

• Intense breast pain that is localized to a specific area
• A distinct area of redness, warmth, or swelling in the breast
• Fever (temperature above 38°C or 100.4°F)
• Flu-like symptoms including body aches, chills, and fatigue
• Symptoms that do not improve after 24 hours of frequent breastfeeding and rest
• Mastitis symptoms that persist or worsen after 24-48 hours of antibiotic treatment
• A lump in the breast that feels different from engorgement

How Is a Breast Abscess Diagnosed?

Breast abscess is diagnosed through physical examination and breast ultrasound imaging. The ultrasound can confirm the presence of a fluid-filled cavity (the abscess) and determine its size and location, which guides treatment decisions. Your healthcare provider may also take a bacterial culture from the pus to identify the causative organism and determine the most effective antibiotics.

Accurate diagnosis of breast abscess is essential because treatment differs significantly from mastitis. While mastitis typically responds to antibiotics and continued breastfeeding, abscesses require drainage in addition to antibiotic therapy. Healthcare providers use a combination of clinical examination and imaging studies to make the diagnosis and plan appropriate treatment.

During the physical examination, your healthcare provider will examine both breasts, looking for signs of infection such as redness, swelling, and warmth. They will gently feel the breast to assess for areas of tenderness, firmness, and fluctuance. A fluctuant area - one that feels soft and movable, as if containing fluid - is characteristic of an abscess and helps distinguish it from the firm, wedge-shaped swelling typical of mastitis.

If an abscess is suspected based on physical examination, ultrasound imaging is typically performed to confirm the diagnosis. Ultrasound is the imaging modality of choice because it is safe for breastfeeding mothers, does not involve radiation, and provides detailed images of breast tissue that can clearly show fluid collections.

Ultrasound examination

Breast ultrasound is a painless, non-invasive test that uses sound waves to create images of the breast tissue. The ultrasound probe is placed on the skin over the affected area, and images appear on a screen in real-time. This allows the healthcare provider to see exactly where the abscess is located, how large it is, and whether there are multiple pockets of pus.

The ultrasound findings help determine the best treatment approach. Small abscesses may be suitable for needle aspiration, while larger or more complex abscesses may require catheter drainage. Ultrasound can also be used to guide drainage procedures, ensuring accurate placement of the needle or catheter into the abscess cavity.

Bacterial culture

When the abscess is drained, a sample of the pus is typically sent to the laboratory for bacterial culture. This test identifies the specific bacteria causing the infection and determines which antibiotics will be most effective against it. Culture results usually take 24-48 hours to return, but treatment is started immediately with broad-spectrum antibiotics while awaiting results.

Bacterial culture is particularly important because some breast abscesses are caused by antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA). Knowing the causative organism allows healthcare providers to adjust antibiotic therapy if needed to ensure the infection is effectively treated.

How Is a Breast Abscess Treated?

Breast abscess treatment requires drainage of the pus collection, which cannot be resolved with antibiotics alone. Drainage is performed using needle aspiration (for smaller abscesses) or catheter placement (for larger abscesses), both typically done under ultrasound guidance with local anesthesia. Antibiotics are prescribed to treat the underlying infection. Most women recover within 1-2 weeks with appropriate treatment.

The cornerstone of breast abscess treatment is drainage - removing the accumulated pus from the abscess cavity. Unlike mastitis, which can often be treated with antibiotics and continued breastfeeding alone, abscesses contain walled-off pus that antibiotics cannot effectively penetrate. Without drainage, the infection will not resolve regardless of antibiotic treatment.

Modern treatment approaches favor minimally invasive drainage techniques over traditional surgical incision when possible. These newer methods are less painful, leave minimal scarring, allow faster recovery, and are associated with higher rates of successful continued breastfeeding. The choice between needle aspiration and catheter drainage depends on the size of the abscess and other factors your healthcare provider will consider.

Treatment is typically performed on an outpatient basis, meaning you can go home the same day. Local anesthesia is used to numb the area before the procedure, so you should not feel significant pain during drainage. Your healthcare provider will explain the procedure and answer any questions you have beforehand.

Needle aspiration

Needle aspiration is the first-line treatment for smaller breast abscesses, typically those less than 3 cm in diameter. During this procedure, the area is numbed with local anesthetic, and a needle attached to a syringe is inserted into the abscess cavity, usually guided by ultrasound imaging. The pus is then withdrawn through the needle and sent for bacterial culture.

Needle aspiration may need to be repeated if the abscess refills with pus. Many women require two to three aspirations before the abscess fully resolves. Follow-up appointments are scheduled to monitor healing and perform additional aspirations if needed. The advantages of needle aspiration include minimal scarring, preservation of milk ducts, and the ability to continue breastfeeding.

Catheter drainage

For larger abscesses or those that do not respond adequately to needle aspiration, catheter drainage may be recommended. This involves placing a small, thin plastic tube (catheter) into the abscess cavity through a small skin puncture. The catheter remains in place for several days, allowing continuous drainage of pus as it accumulates.

The catheter is secured to the skin with tape or sutures and covered with a dressing. You will receive instructions on how to care for the catheter at home and when to return for follow-up. Once drainage has decreased significantly and the abscess cavity is healing, the catheter is removed. This is a simple, painless procedure.

Antibiotics

Antibiotics are prescribed alongside drainage to treat the underlying bacterial infection. Initial antibiotic choice is usually a broad-spectrum antibiotic effective against Staphylococcus aureus, the most common cause of breast abscesses. Treatment may be adjusted based on culture results if the bacteria prove to be resistant to the initial antibiotic.

It is important to complete the full course of antibiotics as prescribed, even if you feel better before finishing them. Stopping antibiotics early can allow the infection to return and may contribute to antibiotic resistance. The antibiotics typically prescribed for breast abscess are compatible with breastfeeding.

Can I Continue Breastfeeding with a Breast Abscess?

Yes, you can usually continue breastfeeding from the unaffected breast throughout treatment for a breast abscess. Breastfeeding from the affected breast may be too painful initially, but you should continue expressing milk by hand or pump to maintain milk production. The breast milk is safe for your baby. Once treatment is complete and pain has subsided, you can resume breastfeeding from both breasts.

One of the most common concerns for mothers diagnosed with a breast abscess is whether they can continue breastfeeding. The good news is that having a breast abscess does not mean you must stop breastfeeding entirely. With appropriate management, most women can continue their breastfeeding journey, although some temporary adjustments may be needed during the acute phase of treatment.

Breast milk from the affected breast is generally safe for your baby, even when you have an abscess. The bacteria causing the abscess do not significantly contaminate the milk, and any bacteria present are typically destroyed in the baby's digestive system. However, some mothers prefer to discard milk from the affected breast during active infection and treatment, and this is a personal choice.

The most important consideration during recovery is maintaining milk production in the affected breast. Even if breastfeeding is too painful, regularly expressing milk by hand or with a breast pump prevents engorgement, maintains supply, and may actually help healing by keeping milk flowing through the breast tissue.

Practical tips for breastfeeding during recovery

Managing breastfeeding while recovering from a breast abscess requires some planning and flexibility. Here are evidence-based recommendations to help you maintain your milk supply and continue your breastfeeding relationship:

• Continue breastfeeding from the unaffected breast: Your baby can continue to nurse normally from your healthy breast
• Express milk from the affected breast: If nursing is too painful, use hand expression or a pump to empty the breast regularly (every 2-3 hours)
• Try different positions: Some breastfeeding positions may be more comfortable than others - experiment to find what works
• Start on the unaffected side: When you resume nursing from the affected breast, start feeds on the healthy side to trigger let-down, then switch
• Use pain relief before feeding: Taking ibuprofen or paracetamol 30 minutes before nursing can make the experience more comfortable
• Apply warm compresses: Gentle warmth before expressing or feeding can help with milk flow
• Seek lactation support: A lactation consultant can provide personalized guidance for your situation

When to avoid breastfeeding from the affected breast

In certain situations, your healthcare provider may recommend temporarily avoiding breastfeeding from the affected breast. This includes cases where the abscess is located very close to the nipple, if a surgical incision was made near the areola, or if there is active pus drainage from the nipple. In these situations, you should continue expressing and discarding milk from that breast until advised otherwise.

Even if you cannot breastfeed from the affected breast, continuing to express milk prevents complications like engorgement and maintains your milk supply for when you can resume nursing. Your healthcare provider or a lactation consultant can advise you on when it is safe to resume breastfeeding from the treated breast.

How Long Does Recovery from a Breast Abscess Take?

Most women recover from a breast abscess within 1-2 weeks after treatment begins. Symptoms typically improve significantly within the first few days of drainage and antibiotic therapy. Complete resolution of the abscess cavity may take up to 2 months. A follow-up appointment is usually scheduled 2-3 months after treatment to confirm complete healing.

Recovery from a breast abscess is generally straightforward once appropriate treatment has been initiated. The combination of drainage and antibiotics addresses both the accumulated pus and the underlying infection, allowing your body to heal. Most women notice significant improvement in pain, fever, and other symptoms within 24-48 hours of drainage.

The timeline for complete recovery varies depending on the size of the abscess, how quickly treatment was started, and individual healing factors. Smaller abscesses that receive prompt treatment tend to resolve faster than larger or more complex abscesses. Even after symptoms improve, it takes time for the abscess cavity to fully close and for the breast tissue to return to normal.

During recovery, it is important to follow your healthcare provider's instructions, complete the full course of antibiotics, attend all follow-up appointments, and monitor for signs that the infection is returning or not healing properly. Most women can return to normal activities fairly quickly, though you may need to modify your routine for the first few days after treatment.

What to expect during recovery

Understanding the typical recovery timeline can help you know what to expect and recognize if something is not progressing normally:

• First 24-48 hours: Significant reduction in pain and fever following drainage. Some discomfort at the drainage site is normal.
• Days 3-7: Continued improvement in symptoms. If you had a catheter placed, it may be removed during this period once drainage decreases.
• Week 1-2: Most women feel substantially better and can resume normal activities. The area may still be tender but should not be severely painful.
• Weeks 2-8: The abscess cavity gradually closes and heals. The breast may have some firmness or irregularity that continues to improve.
• 2-3 months: Follow-up appointment to confirm complete resolution. By this time, most women have fully recovered.

How Can You Prevent Breast Abscess?

Preventing breast abscess focuses on protecting nipple health, treating breast problems early, and maintaining good breastfeeding technique. Key prevention strategies include ensuring proper latch, addressing sore nipples promptly, treating mastitis completely with the full course of antibiotics, and continuing to empty the breasts regularly. Seeking early help from lactation professionals can prevent many breastfeeding complications.

While not all breast abscesses can be prevented, many can be avoided through good breastfeeding practices and prompt attention to early warning signs. Since most breast abscesses develop from progression of mastitis, and mastitis often results from nipple damage and milk stasis, prevention efforts focus on these root causes.

Proper breastfeeding technique is one of the most important preventive measures. A good latch reduces stress on the nipples and ensures effective milk removal. If you are experiencing pain during breastfeeding, difficulty with latch, or other problems, seeking help from a lactation consultant early can prevent these issues from progressing to infection.

Early treatment of any breast problems is crucial. If you develop sore or cracked nipples, address them promptly with proper wound care and latch correction. If you notice symptoms of mastitis such as breast pain, redness, and fever, contact your healthcare provider right away. Completing the full course of antibiotics for mastitis, even if you feel better, helps ensure the infection is fully eliminated.

Prevention strategies

The following evidence-based strategies can help reduce your risk of developing a breast abscess:

• Ensure proper latch: Work with a lactation consultant to achieve and maintain good breastfeeding technique
• Treat sore nipples early: Address nipple pain and damage promptly before bacteria can enter the tissue
• Feed frequently: Regular breast emptying prevents milk stasis, which can contribute to infection
• Treat mastitis promptly: Seek medical care at the first signs of mastitis and complete the full antibiotic course
• Don't skip or delay feedings: Maintain regular breastfeeding or pumping schedule
• Avoid restrictive clothing: Tight bras or clothing that puts pressure on the breasts can impede milk flow
• Practice good hygiene: Wash hands before handling breasts or pumping equipment
• Manage engorgement: If breasts become overly full, express enough milk to relieve pressure
• Get enough rest: Adequate rest and nutrition support your immune system

What Are the Possible Complications of Breast Abscess?

Complications of breast abscess are uncommon with proper treatment but can include recurrence of the abscess, milk fistula (abnormal connection between milk ducts and skin), scarring, and rarely, sepsis if infection spreads. The risk of complications is minimized by prompt treatment, complete drainage, and appropriate antibiotic therapy. Most women recover fully without long-term effects.

When breast abscesses are treated promptly and appropriately, serious complications are rare. However, understanding potential complications helps you recognize warning signs and seek additional care if needed. It also underscores the importance of completing treatment as prescribed and attending all follow-up appointments.

The most common complication is recurrence of the abscess, which occurs in approximately 10-30% of cases. Recurrence is more likely if the initial abscess was large, if drainage was incomplete, or if the underlying risk factors (such as ongoing nipple damage) persist. If you develop symptoms suggesting the abscess has returned, contact your healthcare provider promptly for re-evaluation.

Potential complications

• Recurrent abscess: The abscess may return if not completely drained or if risk factors persist. Multiple drainage procedures may be needed.
• Milk fistula: An abnormal channel may form between the milk ducts and the skin surface, causing milk to leak from the drainage site. This usually heals with time.
• Scarring: Some scarring of breast tissue may occur, particularly with larger abscesses or surgical drainage. This does not usually affect future breastfeeding.
• Premature weaning: Some women choose to stop breastfeeding due to pain or complications, though this is not medically necessary in most cases.
• Sepsis: Rarely, the infection can spread to the bloodstream. This is a serious complication requiring hospitalization. Seek emergency care for high fever, confusion, rapid heartbeat, or feeling extremely unwell.