A 30-year-old breastfeeding mother presents with right breast pain and mild fever. The right breast shows a tender, red, warm segment but no fluctuant collection. What is the most appropriate initial management?

Answer: D. Antibiotics, with continued breastfeeding from the affected side

Lactational mastitis

A breastfeeding woman with a tender, red, warm breast segment and fever, but no fluctuant collection, has lactational mastitis (inflammation, often with infection) rather than an established abscess.

Initial management

• Antibiotics for the infection.
• Continue breastfeeding (including from the affected side) or otherwise keep the breast drained - effective milk drainage is part of treatment and is safe for the baby.

When it becomes an abscess

If a fluctuant collection develops, management escalates to drainage (aspiration or incision and drainage) - source control - alongside antibiotics. Ultrasound helps confirm and guide aspiration of a suspected collection.

Why not the other options

Incision and drainage is for an abscess, not uncomplicated mastitis. Stopping all feeding worsens stasis and is unnecessary. Mammography and core biopsy are inappropriate for an acute inflammatory presentation in a young lactating woman, although inflammatory breast cancer should be remembered if redness fails to settle with treatment.