A 26-year-old lactating mother presents on day 12 postpartum with a fluctuant, tender 5 cm swelling in the upper outer quadrant of the left breast with overlying erythema. She has been treated with flucloxacillin for 5 days without improvement. The most appropriate next step is:

• A Stop breastfeeding permanently on that side
• B Add oral metronidazole and observe for another week
• C Incision and drainage through a circumareolar incision immediately
• D Ultrasound-guided needle aspiration and continuation of antibiotics ✓

Explanation

Lactational abscess is caused most often by Staphylococcus aureus entering through cracked nipples. Failure to improve on appropriate antibiotics indicates abscess formation, and the standard management is repeated ultrasound-guided aspiration combined with continued antibiotics and continued feeding or expression on the affected side, which aids drainage. Incision and drainage is reserved for failed aspiration, and stopping breastfeeding worsens engorgement. Metronidazole adds nothing since the organism is aerobic S. aureus.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.