Breastfeeding 1-2-3

Leaking Breast Milk after Surgery for Breast Abscess or Lumpectomy

by Angela White, J.D., breastfeeding counselor on July 11th, 2008

Recently a reader posted a comment seeking help on the question of leaking breast milk after a lumpectomy. This mother was nursing her one-month-old at the time of the surgery, and had had the incision glued and stitched several times in the month since, but breast milk continued to leak through the stitches. The delay in healing was compounding the stress of the lumpectomy. One doctor recommended weaning through the use of cabbage leaves and binding the breast tightly (please read on for a discussion of the dangers of that!)

While there are many resources online for dealing with breastfeeding initiated after surgery, it is much more difficult to find anything on healing from a lumpectomy or surgery for a breast abscess on a lactating breast. Consultation of several sources of information revealed that there are many options — good ones — for the breastfeeding mother. Armed with information, a mother in this situation can talk to her medical providers for advice and make the best decision for her.

Here is my understanding about healing after surgery on a lactating breast:

1. Continued breastfeeding can be beneficial because it helps prevent engorgement and mastitis (breast infection). By contrast, binding the breast risks complicating the healing with a breast infection.

2. If milk ducts are cut during the surgery, leaking is to be expected.

3. Breast milk has antimicrobial and healing properties that actually can help the wound heal. The leaking breast milk can help keep the area clean and avoid infections common to open wounds.

4. In the case of leaking breast milk, healing takes place from the inside out (rather than from stitches or glue sealing the wound). It helps to understand that healing takes considerably longer (weeks, not days) but that it can happen and not to worry.

5. Gauze can be used to dress the incision. Replace the gauze as needed to keep the area relatively dry (which means replacing it after every feeding, and potentially multiple times in between feedings as necessary). Try to tape the dressing on consistently so that the sides and edges of the wound stay in the same proximity.

6. Consider whether a low-dose prophylactic antibiotic would be helpful. Factors might depend on worry over infection, the mother’s tolerance for antibiotics, and the mother’s tendency to develop thrush (a yeast infection). If the mother does take antibiotics, she should consider taking probiotics/acidophilus/eating yogurt with live cultures to replenish the good bacteria that can keep her from developing thrush.

7. The mother could cut back to nursing just a few times a day on the affected side (say, morning, noon, and before bed) and that will cut back on the milk flow. It would still be necessary to dress the leaking wound with gauze. Once the wound heals, the mother could try to nurse fully again on that side, keeping in mind that it will take a while for the supply to build back up.

8. One-sided nursing is possible. The mother would need to cut back on nursing on the affected side (slowly, so that she does not develop engorgement or mastitis) and nurse considerably more often on the other side (at least twice as often in the beginning), being sure to watch the baby’s urine and stool output and weight gain, to make sure the baby is getting enough milk. Again she could try to re-lactate on that side once the wound heals. One-sided nursing can result in lopsidedness, which may or may not be bothersome. One solution is to use a mastectomy breast prosthesis when it matters.

9. Weaning completely is also an option. Again the mother would want to do so in a manner that limits her risk of breast infection.

Sources for further reading:

1. The Breastfeeding Answer Book, p. 507 on healing after surgery for a breast abscess.

2. Surgery and the Breastfeeding Mother, from Lactation Education Resources.

3. The following discussions, opinions, and personal stories on the breastfeeding professionals’ email listserv Lactnet: one, two, three, and four.

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POSTED IN: breast milk, breastfeeding, cancer, health of the mother