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Breastfeeding issues shouldn’t get this complicated

SINGAPORE — After an untreated breast abscess left Mdm Wei Ling permanently scarred, the mother-of-three now urges other mothers not to take their breastfeeding-related issues lightly.

Breastfeeding issues shouldn’t get this complicated

While uncommon, life-threatening complications from breastfeeding-related problems can occur.

SINGAPORE — After an untreated breast abscess left Mdm Wei Ling permanently scarred, the mother-of-three now urges other mothers not to take their breastfeeding-related issues lightly.

When the administrative executive, who is in her mid-30s, first started breastfeeding in 2013, she had her fair share of common lactation-related issues such as clogged milk ducts and milk blisters.

But she did not expect to develop complications from a bout of mastitis, which is an infection of the breast tissue that causes fever, chills and pain.

Mdm Wei delayed seeing a doctor although her symptoms, which had gone on for three weeks, worsened even after taking antibiotics.

“At the time, there was pressure from family members who told me not to undergo any medical intervention (while breastfeeding). My baby was the first child in the family so everyone was very kan chiong (anxious),” she said.

By the time an ultrasound scan confirmed an abscess in her right breast, the pain was excruciating and she had to be hospitalised. Complications set in after she underwent surgery to drain the abscess.

“The wound broke open and pus kept seeping out. I had to go back to the hospital many times for treatment. On hindsight, I wondered if I could have avoided the surgery if I had gotten medical help earlier,” said Mdm Wei.

She subsequently developed another large abscess — around 4cm in size — in the same area while breastfeeding her second child. It was treated using a procedure known as needle aspiration.

If the abscesses had been untreated, she might have gone into septic shock, said breast surgeon Felicia Tan, director of FeM surgery group.

The potentially life-threatening condition occurs when sepsis, which is organ damage in response to an infection, leads to dangerously low blood pressure. During a septic shock, the body collapses and the organs can shut down, said Dr Tan, who treated Mdm Wei’s second abscess episode.

SEPTIC SHOCK FROM UNTREATED ABSCESS POSSIBLE

While uncommon, life-threatening complications from breastfeeding-related problems can occur.

Every year, Dr Tan — whose breast centre provides mammogram, ultrasound and lactation services — sees one patient who develops a potentially life-threatening complication, like septic shock, as a result of an untreated breast abscess. All the cases were preventable.

An extreme case was a mother who went into septic shock and suffered breast tissue death after undergoing a hot stone massage to relieve pain from an abscess.

“When she first came in, her breast was all red and had a burnt look. By the time I went in 15 to 30 minutes later, the entire skin had started to necrose and turned black. The hot stone therapy had worsened the underlying infection,” said Dr Tan.

Despite medical treatment to remove the dead tissue from the woman’s breast, the infection subsequently spread to her abdomen and thigh. The woman survived the ordeal after a 27-day stay in the intensive care unit.

Women at risk of serious lactation-related complications are typically inexperienced first-time mothers, said Dr Tan. Some are seasoned mothers who may be complacent and brush their breastfeeding issues aside, while others may have had surgical procedures such as fillers or implants done on the breasts, she said.

Abscess occurs in about 3 per cent of mothers with mastitis, which has been reported in up to one in five breastfeeding women, said Dr Yvonne Ng Peng Mei, senior consultant at the department of neonatology at National University Hospital (NUH).

Severe complications such as recurrent mastitis and breast abscess may result from a delay in treatment, or breast infection by unusual and antibiotic-resistant bacteria, she said.

Such complications are rare, however, said Dr Ng, who is also a lactation consultant.

Most women — about nine in 10 — complete their breastfeeding journey without having to see a lactation consultant or breast specialist, said Dr Tan.

NUH’s Dr Ng has not encountered any cases of severe long-term complications from lactation-related breast issues. The women with mastitis she has managed recovered well, and continued breastfeeding, after analgesics, antibiotics and advice on effective breastfeeding.

Milder breastfeeding issues such as engorgement are more common.

For example, up to three in five women may experience moderate engorgement symptoms, said Dr Ng.

There may be breast swelling and warmth, which are considered normal engorgement symptoms between the third and fifth day after birth, just before the breast milk starts flowing, she said. Engorgement can be managed with analgesics, cold packs or cold cabbage leaves.

Information on post-birth breast changes should be provided to mothers before hospital discharge, said Dr Ng.

“Frequent effective breastfeeding in the first 48 hours after birth may be associated with less engorgement. Mothers should also be able to perform breast massage and hand expression to manage engorgement if it occurs. They should learn to check their breasts for lumps, pain and redness, and get help promptly if symptoms do not improve within 24 hours,” said Dr Ng.

WHEN IS IT NOT A BLOCKED DUCT?

According to Dr Tan, breastfeeding-related issues should be seen by a lactation consultant or breast surgeon as they can differentiate between a blocked duct (an area of the breast where milk flow is obstructed), mastitis (infection of the breast tissue) and abscess (collection of pus that forms in the breast).

“An abscess cannot be cleared with massage and will require antibiotics, needle or surgical drainage. If the lactation consultant picks up a problem, the patient should go to a breast specialist next as general practitioners don’t do ultrasound scans, which can tell the difference between an abscess or mastitis,” said Dr Tan.

Women with symptoms that suggest mastitis or breast abscess may also consult an obstetrician or other doctors knowledgeable in breastfeeding, said NUH’s Dr Ng.

Skin-colour changes, fever and chills typically suggest an infection, said Dr Tan. She cautioned against undergoing hot stone massages if breastfeeding mothers suspect any infection, as thermal injury to the skin may complicate matters.

“When there is an abscess, the skin becomes red and ‘unhealthy’. Sometimes, the skin can break and pus can come out on its own. (Furthermore) hot stone therapy is not a sterile procedure,” said Dr Tan.

For Mdm Wei, the emotional toll from her ordeal was worse than the physical pain. Her breast milk supply dropped temporarily and she resorted to formula-feeding.

“The lack of awareness and resources available, the feeling of being judged by people around me and the pressure to do well in breastfeeding — the whole experience was traumatic,” said Mdm Wei.

Currently breastfeeding her third child, aged one, Mdm Wei said her previous experience has made her “paranoid” and she now keeps a watchful eye on any suspicious symptoms.

“As mums, we need to read up more on breastfeeding and not delay getting the right treatment when the need arises,” she said.

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