A 24-year-old lactating mother presents with a painful, fluctuant swelling in the lower quadrant of the right breast with overlying erythema and high-grade fever for 3 days. What is the most appropriate management?

• A Incision and drainage under cover of antibiotics, with continued expression of milk ✓
• B Broad-spectrum oral antibiotics alone with continuation of feeding
• C Immediate cessation of breastfeeding on the affected side and suppression of lactation
• D Fine needle aspiration cytology to exclude malignancy before any intervention

Explanation

B fluctuant, tender breast swelling with fever in a lactating woman indicates a formed lactational abscess, caused almost always by Staphylococcus aureus entering through nipple cracks. B formed abscess requires incision and drainage along skin creases (radial incision), followed by antibiotics. Antibiotics alone will not resolve an established collection. Breastfeeding or regular expression should be continued because milk stasis perpetuates the infection, so abrupt cessation worsens the problem.

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.