Mastitis is an inflammation of the breast tissue with or without an infection. Mastitis is commonly seen in women age from Mastitis occurs commonly in breastfeeding women, but it can occur in post-menopausal women as well due to duct ectasia. Mastitis usually occur in women age from 15 to 45 years. Mastitis with infection is common in breastfeeding women. Mastitis due to inflammatory conditions are usually seen in non-lactating women.
The incidence of mastitis change significantly among populations due to the different breastfeeding techniques and support. Some studies say the incidence is about 33% in lactating women, another study says the incidence is about 10%. Mastitis is more common to occur during the 2nd and 3rd week of breastfeeding, 75%-95% of cases occur during the first 3 months of lactation, but it can occur anytime during lactation.
How Is Mastitis Diagnosed?
The diagnosis is quite straight forward most of the time in lactating women. The doctor can diagnose mastitis from the history and examination (a clinical diagnosis) and if there is any doubt or if mastitis does not get cured after treatment then further investigations are needed. Usually investigations are not needed to diagnose mastitis in lactating women.
Symptoms of mastitis:
- Swelling and redness in the affected part of the breast
- Pain when the affected part of the breast is touched or during breastfeeding
- Discomfort in the breast at all times or when breast feeding
- Fever
- Malaise/fatigue
The other features in the history suggestive of mastitis are:
- Breastfeeding mother or peri-menopausal woman
- Poor technique of breastfeeding – poor attachment
- Infrequent feeds
- Previous history of mastitis
Signs of mastitis:
- Tenderness during breast examination
- Redness and swelling of the affected area
- The affected area is warm to touch
- Sore or cracked nipples
- Lump can be present if abscess is formed
Differential diagnosis:
- Breast abscess
- Inflammatory breast cancer
Investigations:
Usually investigations are not needed, it is a clinical diagnosis.
Gram Stain And Culture Of Breast Milk: There can be false positives from normal bacterial colonization and a negative culture does not mean that the woman doesn’t have mastitis. Culture can be done if the infection is severe, hospital acquired, unusual or if the woman doesn’t respond to appropriate antibiotics within two days. Culture can also be done if there is a local high prevalence of bacterial resistance.
To get a milk culture first mother should clean the nipples and express a little amount of milk from the hand and discard that milk. Then get a sterile container and express milk into the container without touching the milk from the hand. Make sure the nipple does not touch the container as well.
Ultrasound Scan: Can be done if there is a lump or if there is any doubt if it’s inflammatory breast cancer, especially in women who are not breastfeeding currently.
Mammogram: Can be done if there is a lump or if there is any doubt if it’s inflammatory breast cancer, especially in women who are not breastfeeding currently.
Biopsy: If the symptoms persist after a complete course of antibiotics, a biopsy may be needed to exclude inflammatory breast cancer.
Summary
Mastitis is an inflammation of the breast tissue with or without an infection. Mastitis is commonly seen in women age from Mastitis occurs commonly in breastfeeding women but it can occur in post-menopausal women as well due to duct ectasia. Mastitis is a clinical diagnosis, most of the time mastitis can be diagnosed from a good history and performing a thorough examination. Gram stain and culture on milk can be done if the infection is severe, unusual, infection is hospital acquired or the symptoms do not improve with two days after initiation of antibiotics. Ultrasound scan and mammogram can be done if there is a lump or if there is any doubt if it’s inflammatory breast cancer, especially women who are not breastfeeding. Biopsy is done if the symptoms persist after a complete course of antibiotics to exclude inflammatory breast cancer.
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