A woman presents on day 10 postpartum with high fever (39.5°C), rigors, and a tender, engorged left breast with an area of fluctuance. Ultrasound confirms a 4 cm abscess. The MOST appropriate management is:

• A Oral flucloxacillin and continue breastfeeding from the affected breast
• B Ultrasound-guided needle aspiration with oral antibiotics and continue breastfeeding from unaffected side ✓
• C Incision and drainage under general anesthesia and stop breastfeeding
• D Admission, IV antibiotics, and cessation of breastfeeding from both breasts

Explanation

Lactational breast abscess management has evolved to prefer ultrasound-guided needle aspiration (repeated if necessary) plus appropriate oral antibiotics (flucloxacillin or cefalexin for Staphylococcus aureus coverage) over incision and drainage for most abscesses up to 5 cm. This approach avoids scarring, preserves breastfeeding capability, and is equally effective. Breastfeeding should continue from the unaffected breast; the affected breast can be expressed until safe to resume. Incision and drainage is reserved for large (>5 cm), multiloculated, or failed aspiration cases.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.