Lactational infections (associated with breast-feeding):

Infections occurring during breast-feeding are common and usually easily treated with advice from your midwife on more effective ways of letting the baby clear the milk from the breast and simple antibiotics. These infections are commonly associated with cracked nipples and your midwife will be able to give you advice on treatment and avoidance of this problem.

It is best to try to continue to breast feed through mild infections. Occasionally, infections can get so bad that they need either drainage with a needle or even a small operation to allow the infection to the surface by making a small cut into the abscess. Even then it may not be necessary to stop feeding.

Non-lactational infections (not associated with breast feeding):

You may be surprised to know that it is common to for the breast to produce some milk when not breast-feeding and even after the menopause. This milk collects in the ducts behind the nipple where it is reabsorbed or occasionally causes nipple discharge. It is seen on ultrasound as a normal feature of breast. It is called duct ectasia which is not a disease but a description of the appearance.

Generally this milk causes no symptoms but it is a good culture medium infection. Occasionally infection does enter the duct and start causing trouble. Usually the infection is very mild and caused by the sort of bacteria that normally live on the skin but the infection can be more serious. Depending on how bad the infection it causes a range of conditions:

  • Periductal Mastitis: This is a mild infection causing a sense of itching or soreness of the nipple which often lasts a few days and then settles. Sometimes an antibiotic such as metronidazole may be required but needs to be given for at least two weeks to get right into the milk to prevent the problem from returning immediately.
  • Non-lactational breast abscess: This is a more severe infection causing a lump, redness and pain, usually beside the nipple. A prolonged course of antibiotics such as metronidazole or erythromycin generally settles the problem. Very occasionally surgery is required to drain the abscess before it will heal
  • Mammillary Fistula: If a non-lactational abscess progresses in the absence of treatment, then it will tend to discharge at the edge of the nipple and then seem to settle, but untreated it will keep recurring. For some reason we do not understand, smokers are much more likely to get this problem and in smokers the infection is much more likely to fail to respond to antibiotics. If mammillary fistula does not settle promptly, it often goes on to become a chronic problem for which surgery is required. Even then it is difficult problem to treat and can come back. Smokers with this condition must stop to give them the best chance of recovery.