Mastitis is painful but usually settles quickly with antibiotics. If it doesn't, an abscess may form — and that needs draining. In modern practice, ultrasound-guided needle aspiration replaces the old surgical incision for most abscesses, leaving little or no scar.
Mastitis — first 48 hours
Most breast infections start as mastitis: a tender, red, hot segment with fever, chills and flu-like symptoms. Treatment:
- •Oral antibiotic for 7–10 days (flucloxacillin or cephalexin)
- •Paracetamol and ibuprofen for pain
- •Continue feeding/pumping if lactating — drains the milk
- •Warm compress before feeds, cool after
- •Plenty of rest and fluids
If you are not improving in 48 hours, see your surgeon. Ultrasound at this point catches an early abscess.
Abscess — what changes
Persistent painful lump despite antibiotics. The skin over it is red and shiny, sometimes pointing. Fever may persist. Ultrasound confirms a fluid-filled collection.
Drainage — needle first
Modern first-line treatment is ultrasound-guided needle aspiration:
- •Done in clinic, takes 10 minutes
- •Local anaesthetic to numb the skin
- •Fine needle inserted under ultrasound to drain the pus completely
- •Pus sent for culture
- •Patient continues oral antibiotics Most lactational abscesses need 2–3 aspirations a few days apart. Outcome is excellent with minimal or no scar.
When surgical drainage is needed
- •Very large (>5 cm)
- •Multi-loculated (multiple pockets)
- •Failed needle drainage
- •Necrotic overlying skin The modern technique is a small (1–2 cm) incision with washout and primary closure — no longer a packed open wound.
Non-lactational abscess
Less common but more troublesome. Often related to periductal mastitis (smokers, peri-areolar location). Recurrence is high if the underlying duct disease is not addressed — sometimes definitive surgical excision of the affected ducts is needed once the infection has settled.
Recovery
Most patients feel substantially better within 48 hours of drainage. Return to work in 2–3 days. Breastfeeding can continue throughout. Follow-up clinical and ultrasound review at 2 and 6 weeks confirms resolution.