A 35-year-old woman, who is currently breast-feeding her firstborn child, develops an erythematous and inflamed fluctuant area on breast examination. Which of the following statement(s) is/are true concerning her diagnosis and management?

a. The most common organism which would expect to be cultured is Staphylococcus aureus

b. Open surgical drainage is likely indicated

d. If the inflammatory process does not completely respond, a biopsy may be indicated

Infection complicates breast-feeding in fewer than 1:100 women, but these lactational infections still account for 80% of all breast infections. Presumably, gaining access via the skin of the irritated nipple of the nursing woman, Staphylococcus aureus is by far the most common pathogen in this setting. Many breast infections begin as cellulitis, without abscess formation. When an actual abscess is suspected, percutaneous aspiration can establish the diagnosis and allow for bacterial culture and sensitivity testing. Open surgical drainage is the most prudent and effective treatment. Although women may choose to cease breast feeding, there is no absolute indication for this. When mastitis or breast infection is suspected clinically, the possibility of an inflammatory carcinoma must also be entertained. Any inflammatory process that does not respond completely and promptly to antibiotics or drainage should be subjected to biopsy to rule out cancer.