Abscess Anyone? Nursing Bras. Lopsided.

[@llli*babyhiccups]

Hi there, I am a new mom to a wonderful 5 week old baby boy. We have had quite a start with nursing...

Mom’s problem began a couple days before week 2. I had the initial engorgement and it reduced, then my left breast engorged again. I was trying to empty it, but it managed to get a plugged duct that COMPLETELY stopped any expression efforts. Followed directions in “The Womanly Art of Breastfeeding” for two days, no improvement and started to have a fever and all the signs of mastitis. Started antibiotics for mastitis, gave it 2 days, but it was no better, and actually probably worse. I had developed a small blister under the skin that looked like milk. I was desperate to get the plug out, so hubby tried, which made the milk blister bigger-so much for sucking out the plug, there was still nothing coming out (baby couldn’t latch on at all because it was so engorged and he fussed and fussed because NOTHING was coming out at all, no matter how hard he tried). The milk blister was probably about the size of a dime on the skin next to my areola. Soooo after 2 days of at home plugged duct treatment and 2 days of antibiotics with no improvement it was back to the doctor. I got a shot of antibiotics in the butt and stronger antibiotics, a second shot in the butt the next day, day 3 the OB/GYN sent me to the general surgeon because he believed it to be an abscess. Sooo… off to the surgeon’s office immediately (I was probably lucky that the OB was willing to call around to find a surgeon that would see me right then). In the surgeon’s office I was telling him the history of how I got here, when I opened my gown to show him the blister I was talking about, he immediately moved for the needles of numbing medication and the scalpel! I am such a wimp, I HATE needles, the thought of cutting into skin freaks me out, but I managed to lay still and not scream as they did an “Incision and Drainage” procedure. Some of the puss just drained on it’s own, the rest, as hubby put it, “was squeezed out like playdough”. Incision was packed with antibiotic dressing that day and we went back the next day for them to repack. Continued antibiotics at home until the course was complete. Things were looking better and the incision seemed to be healing. I was able to hand express some—initially it came out through the incision, then both the incision and the nipple, then just the nipple—but was unable to breastfeed because the incision was too large and too close to the nipple, this also made it impossible to pump, because the suction REALLY irritated the incision, which the flange sat on top of and rubbed.

This past Monday it was looking good, so I decided to try to pump. I tried a waterproof bandaid to cover the incision. It felt ok while pumping using a manual pump so I could control pressure, etc., but when I took the pump off, my incision was really irritated, as the suction had pulled through the bandaid. I also had a new lump on the underside of my breast. That night I started running a fever. Tuesday I was back in to the surgeon’s office where they did another drainage of 30ccs of fluid. Luckily they were able to do this using a needle through the current incision, rather than a new incision. I was also prescribed another round of stronger antibiotics and the fluid that was drained will be sent to the lab to be cultured. I should find out if it is MRSA tomorrow and it’s back to the dr’s office Monday am for another check.

So the doctor said that I should try to express by hand and with the pump. I can get drops out of the pump or hand expressing and the lump that was drained keeps refilling… I feel like it’s a stretched out balloon that keeps collecting. I can get it to feel soft and empty, but it just fills up again. It’s still more tender than the rest of the breast. Do you think that wearing a tight bra might help to pull that lump back in (it is visible)? That brings me to my next question… I have had terrible luck finding a comfortable nursing bra prior to all this (I have a small rib cage and large cup size), but now baby boy has been nursing exclusively on the right for about 3 weeks, so my right breast is ENORMOUS. I can’t wait to have my left back so I can start working on balancing the work load! Where are the best places for nursing bras? How do you measure… I have used a few of the online calculators and they give me sizes varying from 32 FFF to 36 B! I ordered a couple, but they don’t fit at all/were completely uncomfortable, so I have to send them back. With the size difference in my breasts, I realize I’ll probably have to stuff the smaller side or use something with very flexible stretchy cups. If it seems like a tight bra to control my lump might help, hubby had the idea of using a sports bra that fits on the left and cutting out a big hole for my right breast. Thoughts?

Background information (I’ve seen that you ask for this information in follow-ups):

Born 38 weeks-induced due to placental tear/rupture. We had pitocin, pain meds, and an epidural because the pit drip had me contracting every minute really strong for HOURS and they wouldn’t let me move due to all the monitors for baby. I would have preferred fewer meds, but was really happy to have a healthy baby. Day 2 we met with the lactation consultant and she gave me a nipple shield to help him latch because I had flat nipples. This was great because it allowed us to nurse, which wasn’t working too well before.

Weights: (not on the same scale-some pediatrician, some lactation consultant
Birth-7lbs. 1oz. (lots of IV fluids involved)
1 week- 6lbs. 11oz. (pediatrician’s office w/diaper and lactation consultant w/diaper)
2 weeks-6lbs. 5oz. (pediatrician’s office w/diaper)
3 weeks-6lbs. 8.5oz. (lactation consultant w/diaper)
4 weeks-7lbs. 0oz. (pediatrician’s office w/diaper)
5 weeks-today… no weight check today

Output has been pretty consistent with 7-10 wet and poopy diapers each day.

In the first week, we used the nipple shield and he did ok, but was constantly knocking it out of the way. The lactation consultant helped us to transition away from the nipple shield at the end of first week. He was really sleepy for the first two weeks, so we nursed every 2-3 hours because he didn’t demand and he was sleepy when I did wake him up to feed. The pediatrician was concerned that he wasn’t back up to birth weight by week 2, but didn’t suggest supplementing and just asked that we visit the lactation consultant to check and see how things were going—thank you breastfeeding supportive pediatrician!
We are now feeding on demand, which is sometimes 45 minutes per hour for 4 hours straight! Heavy load for one breast to carry! Probably 12+ feedings per day, but I got to stressed when I tried to record them, so I stopped. Unfortunately, with all that feeding, I don't get a chance to work on expressing from the left much at all... maybe 2-3 times per day (it seems to take forever... get hot compress ready, heat, massage, hand express, pump... all for drops of milk--there must still be a plug in place somewhere)

Any ideas/help/support appreciated!

[@llli*lllmeg]

Wow what an ordeal! Awesome for hanging in there mama!

I can't help much with the bra ideas, sorry! There are online places but i am no up on that, hopefully others will have ideas. I personally wear nursing sleep bras and nursing tank tops most of the time, because comfort is more important to me than support. You can also ask around locally for a good bra fitter so you can be measured to know your accurate measurements.

I would be very cautious about a tight bra! you don't want to get another plug.

As far as getting the milk out-have you tried letting baby nurse on that side again? Is this something you have been told not to do? What about a nipple sheild? When I had a Moby Whale of a plug, engorgement and mastitis with current baby, nothing came out for pump (not even hospital grade) or, at first, even hand expression. I had to nurse, even though it was incredibly painful, or explode.

Otherwise I can only suggest keep doing hand expression and pumping at very very low setting, maybe with some kind of thick gauze between injury and pump sheild. It may help to express very very often, but maybe for shorter sessions if that works better.

[@llli*barnheartbabe]

For online bra shopping, I'd recommend birthandbaby.com and breakoutbras.com. Both have had excellent over the phone support for me trying to find options for myself (34 (F, FF, G) depending on manufacturer and individual fit of the bra itself). I've ended up with wireless bras from Anita (style 5068) as well as a HotMilk bra in a fuller coverage style. Love (!!!) both bras as they are supportive and comfortable without being constricting.

[@llli*babyhiccups]

Thanks for the replies! I appreciate the suggestions.
lllmeg-no, baby couldn't nurse on the left, earlier because it was just too tough for his little mouth. He would just wail because nothing came out.

Update: I was admitted to the hospital last night for surgery to open the incision and drain deeper. Thy also flushed the area to ensure any remaining infection was cleared. IV antibiotics and antibiotic packing. Surgeon is going to consult with the infectious disease doctor too to determine correct antibiotic. They both understand and respect my desire to continue breastfeeding, so they are trying to find an option that will be compatible. I was also really impressed with the triage nurses, because they immediately found me a private room in the ER-even though there were other people who had already been there 4 hours- because they didn't want my 5 week old to wait in the main room and be exposed to the other people's germs. (They had breastfeed themselves).

Baby boy did need to go on formula last night, because I didn't have any milk frozen with everything going on and he can't stay at the hospital with me. Also have to pump and dump for at least 48 hours due to the general anesthesia for the surgery. Waiting to see if the antibiotics will be baby friendly or not.

Next big decision:to left left side dry up based on the trouble I've had or try to build up milk supply once it has healed. Does anyone know the statistics for reoccurrence of plugged ducts and mastitis in women who have had them before? I've read it is an increased risk, but would like to know incidence rates/risk to help me decide.

Thanks for the bra suggestions! I'm all about comfort too!

[@llli*mommal]

I don't think there are any reliable statistics kept on the incidence of plugged ducts; almost all of them resolve without medical intervention so no-one is going to publish anything about them. Mastitis also frequently resolves without medical treatment- empty the breast as much as possible and the mastitis usually goes away, without a mom needing to see a doc for antibiotics. But there is definitely a relationship between getting plugged ducts/mastitis and getting them again. Some women are highly prone to one or both conditions.

Here's the crazy thing: even if you wean completely from both breasts, there is still a chance of getting mastitis or an abscess. I know someone IRL who has suffered from abscesses repeatedly since her first child was born, even though both her children were weaned within a few weeks/months of birth. Again, it doesn't seem like there's much data on incidence- this was the best sourceI found: http://onlinelibrary.wiley.com/doi/1...4.00272.x/full But I only did a quick search of Google Scholar and you might want to do some more digging.

[@llli*auderey]

you might want to look online for sellers of mastectomy bras? you might be able to call them and see if they have anything that might work. though i also would be wary of too-tight on the damaged breast.

[@llli*bfwmomof3]

Hi mama,
wow, you've had a rough road, that's so wonderful that you are keeping at it!

With regards to pumping and dumping due to anesthetic: check out this thread: http://forums.llli.org/showthread.ph...t-moment-today
One of our mamas is a surgeon and investigated this issue for a breastfeeding mother she operated on. That mother did one pump and dump after having general anesthesia. Mommal's suggestion to call infantrisk is a good one, but since they are only open weekdays, you might find out if there is a LC in the hospital who can offer advice today? It would be a shame for you to be pumping and dumping when it's not really necessary.

[@llli*lllmeg]

Wow, so sorry you were back in the hospital! I am glad the staff helped you make the best of it.

I am also glad your doctors respected your desire to breastfeed as of course they should. To bad they told you to pump and dump as that is almost certainly not the case.

FYI, here is a clinical protocol for approaching mastitis and breast abscess in the nursing dyad. http://www.bfmed.org/Media/Files/Pro..._4mastitis.pdf

You have been really, really sick and under great stress. I suggest, this is not the best time to be making decisions that are going to impact your life so much. Why not give it a day or two before deciding whether to "let your breast dry up?"

Yes mastitis does re-occur in some mothers. But many more mothers have mastitis once (or never) over many children. And mastitis is not usually the nightmare you have been through. Usually it's a fever, aches, chills, antibiotics and rest and your done. Not fun, but not anything like you have been through. Abscess that requires drainage or surgery and being as sick as you have been from mastitis is rare.

Reoccurrence can be due to mom not getting adequate treatment the first time around, or continuing the same practices that led to the first bout (for example, scheduling feeds, or not correcting a poor latch, etc.)

Some mothers are more prone to plugs, due to milk fat content or overproduction, and plugs may in turn may lead to mastitis. (but do not always.) There are things one can do to reduce chances of plugs (for example, diet changes, taking lecithin.) Overproduction can be reduced if that is part of the problem. If you would like more info on this let us know.

In general The best ways for any mom to avoid mastitis is
:to not allow the breast to get overfull-nurse (or pump if you cannot nurse) frequently. And make sure baby is able to extract milk reasonably effectively (this is where correcting a poor latch comes in.)
:Not get run down physically-make sure you get adequate rest and nutrition and fluids and reduce stress.
:Treat nipple injury (open wounds) with topical antibiotic cream.
:If mastitis occurs, treat with a full treatment of antibiotics. But antibiotics alone are not going to break up or eliminate a plug if that is part of the picture. Newer ideas for handling plugs include vibration, ultrasound treatments and cold packs (to reduce inflammation.)

Recurrent mastitis and plugged ducts: http://kellymom.com/bf/concerns/moth...rent-mastitis/
Dealing with plugs and blebs: http://www.llli.org/docs/00000000000...plugsblebs.pdf

I hope you feel better soon!

[@llli*babyhiccups]

Thank you all! Found out it is a MRSA infection. They are putting me on antibiotics that are ok for nursing and now that I'm over 24 hours post-op I can give little guy the milk I pump and they are letting me get dressed and go downstairs to visit with baby when grandparents bring him over! (This floor was deemed unsafe for baby to stay the night, so I'd rather him not be here at all). Still waiting to hear if I'll be discharged today or tomorrow.

The I you lllmeg. Don't worry, I am not planning on making any decisions right now. I plan to leave options open, just starting to gather some information to inform my decision.

If baby has only had formula Friday night through Sunday or Monday (I sent home the first bottle of breast milk for him instead at lunch time and will continue to send as much as I can!), do I need to wean him back to BF full time, or can we just switch back? My supply shouldn't be down too much from just a couple days of pumping instead of nursing, right?

[@llli*lllmeg]

As long as you have maintained your production via pumping you should be able to just switch back, even if you have not been able to pump that much, because we are talking just two or three days. Once you are nursing again, if you are concerned that baby is not getting enough, watch output (pees and poops) for a week. Be aware that formula changes gut flora so poops may look different (color and consistency may change) and be more or less frequent than normal for a few days post formula supplement. just to make life even more interesting, your baby is also getting to the age when SOME breastfed babies start going days between poops and it's fine. So don't let that scare you. In that case, if you are at all worried, you could get a weight check. Don't assume you need to supplement unless weight gain takes a hit. If you have had a dip in production from not nursing, illness and stress, the fastest way to get it back is to nurse nurse nurse (or pump if you cannot nurse.)

You are doing amazing, this whole thing must be so difficult!