Mastitis is a term used to denote localized swelling and inflammation of the breast tissue, most commonly affecting only one breast. Breastfeeding females are mostly affected by mastitis, usually during the first six months after birth of a child. It generally, affects women within the first three months after delivery; however, it can affect non-breastfeeding females too. It necessarily is not associated with a bacterial infection, but when present, most commonly involved bacteria are Staphylococcus aureus; and less commonly beta-hemolytic Streptococcus and Escherichia coli.
What Are The Symptoms Of Mastitis?
When mastitis is secondary to breastfeeding, it is termed as lactation/puerperal mastitis and when it occurs in non-breastfeeding women, it is known as periductal mastitis. The symptoms of mastitis are localized to the affected breast area; however, general symptoms such as fever, chills, fatigue and aches may also pursue.
The affected breast may feel red and swollen, which is usually present on the upper and outer part of the breast. This area may be hot and painful to touch or breastfeeding. Breast hardness or a breast lump may also be felt. The pain and redness may radiate to the whole breast. On some occasions, white nipple discharged may be noted with streaks of blood in it.
When symptoms of mastitis are overlooked and it is associated with bacterial infection, then it can lead to localized abscess in the concerned breast. However, this incidence is very uncommon, with an incidence rate of 3%. This breast abscess can further become malignant and turn into a full blown sepsis in immune-compromised patients (such as HIV patients) or patients with a history of breast prosthesis in place. Generally, septicemia is extremely rare in immunocompetent patients.
Risk Factors Associated With Mastitis
The risk factors that are associated with mastitis include a previous history of mastitis. Breastfeeding women usually develop mastitis due to stasis of milk within the breast and reduced outlet of milk. This may be due to incomplete drainage of breast milk that may be secondary to poor positioning of the baby or attachment of the baby, baby born with a tongue-tie and experiencing problem sucking and missing feeds, longer intervals in between feeds and/or abrupt/rapid weaning. It may also occur due to chronic milk oversupply or engorged breast. Other possible reasons for mastitis are tight clothing that may cause external pressure to the breast area, trauma to the breast or nipple as in piercing and/or fatigue, stress, malnutrition and general poor health.
The risk factors that are associated with breast abscess include superimposed bacterial infection, sudden weaning at the time of acute mastitis and/or incompletely treated mastitis. The risk factors that may lead to sepsis in mastitis include immune-compromised state of the mother or mother with a history of breast implant.
Management Of Mastitis
The proper management of mastitis includes timely diagnosis of the condition. The diagnosis is based on the signs and symptoms and clinical evaluation. If the signs of mastitis are severe or otherwise, then other investigations, such as breast culture, CBC, CRP or mammogram can be carried out.
Mastitis management is hassle free and once recognized the symptoms can be treated easily. Self-help measures go a long way in treating and avoiding mastitis in the near future. It is important to note that breastfeeding should not be discontinued during mastitis, as this would make the symptoms worse. To prevent complications of mastitis, regular breastfeeding and/or expressing is necessary to maintain adequate milk drainage.
The symptoms of pain and fever can be reduced with the intake of paracetamol and the signs of inflammation can be alleviated by taking ibuprofen or other NSAIDs. If the signs do not improve within 12-24 hours, then antibiotics can be prescribed.
If the mother develops breast abscess, then a confirmatory ultrasound should be undertaken and if it is positive for abscess then in addition to antibiotic therapy, needle aspiration or surgical drainage may be required. Close monitoring is required and breastfeeding should be continued despite the abscess.