Mastitis

The prevalence and predisposing factors of mastitis in lactating mothers in puerperium. The New Indian Journal of OBGYN, 5(1), 30-34. (2018).  

This study found that mastitis occurs in 2-24% of breastfeeding women from several weeks up to one year after delivery.[3]

• Milk Stasis:

  Incomplete or infrequent milk removal due to factors like engorgement, plugged ducts, tight clothing, or poor latch.

• Nipple Trauma:

  Cracked or damaged nipples provide an entry point for bacteria.

• Bacterial Infection:

  Often caused by Staphylococcus aureus or Streptococcus species.

• Maternal Factors:

  Stress, fatigue, illness, and poor nutrition can compromise the immune system.

• Breastfeeding Practices:

  Inconsistent feeding patterns, abrupt weaning, and improper hygiene can increase risk.

• Previous Mastitis:

  A history of mastitis increases the likelihood of recurrence.

Please note that this is just a summary of risk factors covered in the book. For a more comprehensive understanding, it is recommended to consult the reference text directly.[4]

1. Milk Stasis:

   Incomplete milk removal leads to milk stasis, creating a favorable environment for bacterial growth.

2. Bacterial Invasion:

   Bacteria, most commonly Staphylococcus aureus, enter the breast through cracks or fissures in the nipple.

3. Inflammatory Response:

   The body reacts to the bacterial invasion, causing inflammation and swelling.

4. Ductal Blockage:

   Inflammation and swelling can block milk ducts, further exacerbating milk stasis.

5. Tissue Damage:

   In severe cases, the infection can lead to abscess formation and tissue damage.

Key Points:

• Mastitis is primarily caused by a bacterial infection.
• Milk stasis is a major contributing factor to mastitis.
• The inflammatory response plays a crucial role in the pathogenesis of mastitis.

Please note that this is a simplified explanation of the pathogenesis of mastitis. The actual process can be more complex and involve various factors. For a more comprehensive understanding, it is recommended to consult the reference text directly.[5]

• Localized Breast Pain:

  Pain is often described as throbbing, aching, or burning and is usually focused in one area of the breast.

• Breast Swelling and Redness:

  The affected area may appear swollen, warm to the touch, and red or pink.

• Flu-like Symptoms:

  Fever, chills, body aches, and fatigue are common systemic symptoms.

• Nipple Changes:

  The nipple may appear cracked, blistered, or sore.

• Changes in Milk:

  Milk may appear watery, lumpy, or even contain streaks of blood or pus.

Additional Clinical Features (Not specifically mentioned in the book):

• Hardened Area in the Breast:

  A firm lump or area of engorgement may be palpable.

• Tender Axillary Lymph Nodes:

  Lymph nodes under the arm on the affected side may be swollen and tender.

Please note: This is just a summary of clinical features. The severity and presentation of mastitis can vary, and not all symptoms may be present in every case. It’s important to consult a healthcare professional for proper diagnosis and treatment.[5]

1. Inspection:

   • Observe the breasts for asymmetry, redness, swelling, or areas of warmth.
   • Look for skin changes like dimpling, peau d’orange (orange peel appearance), or nipple changes (cracks, blisters, discharge).

2. Palpation:

   • Gently palpate the breasts for areas of tenderness, firmness, or masses.
   • Check for enlarged or tender axillary lymph nodes.
   • If a fluctuant mass is felt, it may indicate an abscess.

3. Expression of Milk:

   • Express milk from the affected breast to assess for changes in color, consistency (watery, thick, lumpy), or presence of blood or pus.

4. Vital Signs:

   • Measure temperature to assess for fever, which is a common symptom of mastitis.

5. Additional Assessment:

   • Inquire about the patient’s medical history, breastfeeding practices, and current medications.
   • Ask about the onset and duration of symptoms, pain severity, and any associated symptoms like chills or fatigue.

Important Considerations:

• Early diagnosis and treatment of mastitis are crucial to prevent complications.
• Clinical examination should be done with a gentle touch to avoid further pain or discomfort.
• If mastitis is suspected, it is important to differentiate it from other breast conditions like abscess, plugged duct, or inflammatory breast cancer.
• Further diagnostic tests (e.g., milk culture, ultrasound) may be warranted in some cases.[6]

1. Abscess Formation:

   If left untreated, mastitis can progress to form an abscess, a localized collection of pus within the breast tissue. This requires surgical drainage or needle aspiration.

2. Recurrent Mastitis:

   Women who experience mastitis are at increased risk of recurrence, especially if underlying risk factors are not addressed.

3. Chronic Mastitis:

   In rare cases, mastitis can become chronic, persisting for weeks or months despite treatment. This may require further investigation and specialized care.

4. Impaired Milk Production:

   Severe or prolonged mastitis can lead to decreased milk supply in the affected breast.

5. Psychological Impact:

   Mastitis can cause significant pain and discomfort, leading to emotional distress and negatively impacting breastfeeding experience.

Additional Complications (Not specifically mentioned in the book):

• Sepsis:

  In rare cases, untreated mastitis can lead to sepsis, a life-threatening systemic infection.

• Infant Infection:

  Although uncommon, bacteria causing mastitis can be transmitted to the infant through breast milk.

It is important to note that timely diagnosis and treatment of mastitis can significantly reduce the risk of complications. If you suspect you have mastitis, consult a healthcare professional promptly.[5]

1. Physical Examination:

• A thorough breast examination is the first step in diagnosing mastitis. The healthcare provider will look for signs of inflammation, such as redness, swelling, warmth, and tenderness. They may also check for enlarged lymph nodes under the arm.

2. Milk Expression and Observation:

• Expressing a small amount of milk from the affected breast can help determine if the milk is discolored, thickened, or contains blood or pus. This can be an indication of infection.

3. Milk Culture (Optional):

• A milk culture is not routinely recommended for uncomplicated mastitis. However, if symptoms are severe, persistent, or recurrent, or if there are concerns about antibiotic resistance, a milk culture may be performed to identify the specific bacteria causing the infection.

4. Other Tests (Rarely Needed):

• In rare cases, additional tests like ultrasound or biopsy may be needed to rule out other conditions that can mimic mastitis, such as breast abscess or inflammatory breast cancer.

Important Considerations:

• The decision to perform additional investigations depends on the severity of symptoms, the individual’s medical history, and the clinical judgment of the healthcare provider.
• It is important to note that not all cases of mastitis require investigation beyond a physical examination and milk expression.
• If you suspect you have mastitis, consult with a healthcare professional for proper diagnosis and treatment.

1. Effective Milk Removal:

• Frequent and complete emptying of the breasts is crucial to prevent milk stasis, a major risk factor for mastitis.
• Ensure proper latch and positioning during breastfeeding to facilitate optimal milk transfer.
• If the baby is unable to nurse effectively, express milk manually or with a pump to maintain milk flow.

2. Nipple Care:

• Prevent nipple trauma by ensuring a proper latch and avoiding forceful removal of the baby from the breast.
• Use soothing nipple creams or ointments to keep nipples hydrated and prevent cracking.
• Seek help from a lactation consultant if experiencing nipple pain or latch difficulties.

3. Hygiene:

• Wash hands thoroughly before and after breastfeeding or handling breast pumps.
• Clean breast pump parts regularly according to manufacturer’s instructions.
• Change nursing pads frequently to prevent moisture buildup and bacterial growth.

4. Supportive Practices:

• Get adequate rest and sleep to maintain a healthy immune system.
• Eat a balanced diet rich in nutrients to support overall well-being.
• Manage stress through relaxation techniques or seeking support from others.
• Avoid tight clothing or bras that can restrict milk flow.

5. Early Recognition and Treatment:

• Be aware of the early signs and symptoms of mastitis, such as breast pain, redness, swelling, and fever.
• Seek prompt medical attention if you suspect mastitis to prevent complications and ensure timely treatment.

Please note that this is just a summary of prevention strategies covered in the book. For a more comprehensive understanding, it is recommended to consult the reference text directly.[4]

• Continue breastfeeding or pumping: Frequent milk removal is crucial for healing. Start nursing on the affected side first to help with emptying.
• Rest: Get plenty of rest to help your body fight the infection.
• Hydrate: Drink plenty of fluids to stay hydrated and support milk production.
• Pain relief: Take over-the-counter pain relievers like ibuprofen or acetaminophen (if not contraindicated).
• Warm compresses: Apply warm compresses to the affected breast before and during feeding to help with milk flow and pain relief.
• Cold compresses: Use cold compresses between feedings to reduce inflammation and pain.
• Gentle massage: Gently massage the affected area while breastfeeding or pumping to help with milk flow.
• Consult a healthcare professional: Seek prompt medical attention for diagnosis and treatment. Antibiotics may be necessary.
• Practice good hygiene: Wash hands frequently and keep nipples clean and dry.
• Wear a supportive bra: A supportive bra can help reduce discomfort and provide support.

Mastitis Don’ts:

• Don’t stop breastfeeding: Unless advised by a healthcare professional, continue breastfeeding as it helps clear the infection.
• Don’t ignore symptoms: Early treatment is important to prevent complications. Seek medical attention if symptoms worsen or do not improve within 24-48 hours.
• Don’t apply heat before feeding: Heat can increase inflammation and worsen pain.
• Don’t massage vigorously: Gentle massage is okay, but avoid deep or forceful massage as it can damage breast tissue.
• Don’t wear tight clothing or bras: Tight clothing can restrict milk flow and exacerbate symptoms.
• Don’t delay seeking help: If you’re unsure about your symptoms or treatment, consult a healthcare professional or lactation consultant.

Please note that this is general advice, and individual recommendations may vary. It is always best to consult with a healthcare professional for personalized guidance.

• Mastitis:

  Inflammation of the breast tissue, usually caused by a bacterial infection.

• Lactational Mastitis:

  Mastitis occurring in breastfeeding women.

• Non-Lactational Mastitis:

  Mastitis occurring in women who are not breastfeeding.

• Acute Mastitis:

  Sudden onset of mastitis symptoms, usually accompanied by fever and localized breast pain.

• Chronic Mastitis:

  Persistent or recurrent mastitis that lasts for weeks or months.

• Subclinical Mastitis:

  Mastitis that does not cause obvious symptoms but can be detected through milk analysis.

• Clinical Mastitis:

  Mastitis with visible signs and symptoms, such as breast pain, redness, swelling, and fever.

• Milk Stasis:

  Incomplete or infrequent milk removal from the breast, leading to engorgement and increased risk of mastitis.

• Plugged Duct:

  Blockage of a milk duct, causing localized pain and swelling.

• Abscess:

  A collection of pus within the breast tissue, often a complication of untreated mastitis.

• Inflammatory Breast Cancer:

  A rare but aggressive form of breast cancer that can mimic the symptoms of mastitis.

• Galactocele:

  A milk-filled cyst that can develop in the breast during lactation or weaning.

• Mammary Duct Ectasia:

  A benign condition characterized by widening and inflammation of the milk ducts.

• Periductal Mastitis:

  Inflammation of the tissue around the milk ducts, often associated with smoking.

• Lactation Consultant:

  A healthcare professional specializing in breastfeeding support and management.

• Antibiotics:

  Medications used to treat bacterial infections, often prescribed for mastitis.

I hope this list is helpful! If you have any other questions, feel free to ask.

There are several ways to search for information on mastitis:

Online Resources:

• Search Engines: Use search engines like Google, Bing, or DuckDuckGo with keywords like "mastitis," "breast infection," or "breastfeeding complications."
• Reputable Websites: Consult reliable websites like the Mayo Clinic, Cleveland Clinic, WebMD, or the National Institutes of Health (NIH) for comprehensive information on mastitis.
• Medical Databases: If you’re looking for scientific publications or research articles on mastitis, search databases like PubMed, Google Scholar, or ScienceDirect.

Offline Resources:

• Medical Textbooks: Refer to medical textbooks like "Breastfeeding A Guide for the Medical Profession" by Ruth A. Lawrence and Robert M. Lawrence, or "Core Curriculum for Lactation Consultant Practice" edited by Nancy Mohrbacher, for in-depth information on mastitis.
• Medical Libraries: If you have access to a medical library, you can search for books, journals, and articles on mastitis.
• Healthcare Professionals: Consult with a doctor, nurse, lactation consultant, or other healthcare provider for personalized advice and guidance on mastitis.

Specific Search Tips:

• Use specific keywords: Instead of just searching for "mastitis," use more specific terms like "mastitis symptoms," "mastitis treatment," or "mastitis prevention."
• Combine keywords: You can combine multiple keywords to narrow down your search, such as "mastitis antibiotics" or "mastitis breastfeeding."
• Use filters: Many search engines and databases allow you to filter your results by date, publication type, or language.
• Check the source: Always evaluate the source of information to ensure it’s credible and reliable. Look for articles published in reputable journals or websites written by healthcare professionals.

By using a combination of online and offline resources, you can find a wealth of information on mastitis. Remember to consult with a healthcare professional for any medical concerns or questions.