Periductal mastitis (PDM) is also a type of duct ectasia, the milk ducts under the nipple becomes widen and fill with a thick fluid and cause obstruction of the duct. The fluid buildup and irritate the surrounding tissue which leads to inflammation and/or infection of the duct and the breast tissue.
Periductal mastitis is a rare condition and more common in younger women who are breastfeeding. The symptoms are quite similar to duct ectasia. Sometimes it is confused with breast carcinoma as periductal mastitis also has a lump, even from imaging studies it is difficult to differentiate periductal mastitis from breast carcinoma.
5 Risk Factors for Periductal Mastitis
The exact cause of periductal mastitis is unknown; there are several risk factors and possible causes identified in women with periductal mastitis. Histologically it’s a chronic inflammatory condition of the breast with dilatation of the ducts, infiltration of cells and chronic abscess formation.
- Bacterial Infection: Bacterial infection has been found in many women with periductal mastitis in some studies and in some women periductal mastitis was not associated with any infection. The matter remains controversial for a long time now, one study suggested that it is not the bacterial infection that causes periductal mastitis, but the immune response by the immune system to fight the bacteria might cause periductal mastitis. However, more study results are needed to confirm whether bacterial infection cause periductal mastitis or not. The organisms that are associated with periductal mastitis are Staphylococcus aureus, Bacteroides species, anaerobic streptococcus and Pseudomans aeruginosa.
- Nipple Retraction: Nipple retraction could cause changes in the structure of the breast and affect the lactation. This leads to accumulation of fluid and breast milk, which can obstruct the ducts and cause periductal mastitis. About 1/4 of women with periductal mastitis has nipple retraction. Therefore, nipple retraction is a well-known risk factor for periductal mastitis.
- Smoking: Smoking is considered as a risk factor for periductal mastitis, even for duct ectasia it is considered as a risk factor. Periductal mastitis is seen more in women who smoke, therefore, it can be a risk factor for periductal mastitis. Research has found that the toxic substances in cigarette smoke directly or indirectly damages the walls of the milk ducts, which leads to inflammation of the ducts and the breast tissue. This environment is quite favorable for bacteria to grow and multiply which leads to an infection.
- Obesity: Obesity is also considered as a risk factor for periductal mastitis. Studies have shown that obesity is related with breast abscess. Obesity is associated with low-grade chronic inflammation which affect the immune function of the breast. It also affect the estrogen levels of the breast tissue. This influence on the immune function and the estrogen level of the breast tissue can predispose to periductal mastitis.
- Reproductive Factors: There is a controversy whether certain reproductive factors like late onset menarche, parity, duration of breastfeeding are risk factors or not for periductal mastitis. Some studies suggest these are associated with periductal mastitis, some studies say it’s not. More research is needed to see if the hormonal changes have any effect on periductal mastitis.
Summary
Periductal mastitis (PDM) is also a type of duct ectasia, the milk ducts under the nipple becomes widen and fill with a thick fluid and cause obstruction of the duct. The fluid buildup and irritate the surrounding tissue which leads to inflammation and/or infection of the duct and the breast tissue. The exact cause is unknown, but there are few possible causes and risk factors for periductal mastitis. Bacterial infection is one of the causes that remains controversial between doctors for a long time. Some studies suggest that bacterial infections causes’ periductal mastitis, some studies say that it’s the immune response to the bacterial infection that causes periductal mastitis, not the infection itself. Nipple retraction is a risk factor/cause which is well-known. Smoking, reproductive factors and obesity are also considered as risk factors but more research is needed to prove it.
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