Mastitis is defined as the inflammation of breast tissues. The breast is made up of several glands and ducts that are directed towards the areola and nipple. These ducts are responsible for carrying milk. When these ducts get blocked or invaded by bacteria, it leads to the condition.
The commonest complaint of patients with mastitis is pain. There is also localized breast erythema and the area affected may be febrile to touch. Patients may also develop fever which may be associated with chills and rigor. Lactating mothers may report episodes where have been unable to feed their babies. Mastitis sometimes develop into breast abscesses .
Diagnosis of mastitis can usually be made by a detailed history and physical examination. However, laboratory investigations may be ordered like complete blood count and differentials to get the blood picture. Also, part or the nipple discharge may be sent for microscopy culture and sensitivity.
Ultrasound is a very important investigations as it helps to confirm a collection in the case of an abscess. It will also assist in obtaining a needle aspirate and it rules out other differential diagnoses . A mammogram should also be ordered to rule out other mimicking conditions.
First line treatment is home care and it involves massaging the affected area with warm compress, showers, frequent feeding, adequate hydration, avoiding tight clothing, proper emptying of breasts, and offering the alternate breast after each feed. Expression of milk in between feeds so that the milk doesn’t clog in the ducts can also relieve the symptoms.
Antibiotics are also used depending on the causative organisms. The most common ones are amoxicillin and cephalexin which are effective against Staphylococcus aureus. Vancomycin is used in methicillin-resistant strains .
Analgesics are used to relieve pain and are used carefully in lactating mothers. There is new evidence to show that administering lactobacilli, a commonly occurring normal flora in breast milk helps to prevent infectious mastitis in breastfeeding women. If it develops into an abscess, an incision and drainage is done .
The cause of mastitis is either infectious or non-infectious. Infectious causes are bacterial and implicated pathogens include Staphylococcus aureus, Streptococcus spp, Escherichia coli, Salmonella and Mycobacteria. Candida and Cryptococcus have also been identified in rare instances. Bacteria enter the duct usually through a crack in the nipple. Recent studies however suggest that pathogens may actually play a slightly less important role than initially thought.
Mastitis can also be caused by blocked ducts. This can be brought about by incomplete emptying of breasts due to milk stasis or incorrect feeding techniques. Wearing of tight fitting or ill-fitting bras can compress the breast and lead to this condition. It can also result from trauma like a seat belt injury, contamination of breast implants or piercings .
Mastitis is a problem in lactating women and affects as much as 10% of breastfeeding mothers globally. Most episodes of mastitis occur in third or fourth week postpartum and 95% of cases are reported within three months postpartum .
Mastitis results from poor milk drainage rom the ducts. There are two forms of mastitis, the first is an acute form and it may present as an abscess in the breast. The chronic form is usually a secondary manifestation of underlying systemic diseases that leads to colonization with pathogens which are rare in healthy women.
During an acute phase, plasma cells, fatty acid crystals and leukocytes get accumulated in the duct spaces and result in a painful, swollen lump. There could also be a whitish discharge noticed from the nipple .
Mastitis in elderly patients if untreated for long leads to the formation of granular tissue.
Mastitis can be avoided by staying well hydrated and taking plenty of rest. Feeding frequently is encouraged and milk should be expressed whenever the breasts feel full. Proper latching of baby on the breast should also be practiced. Proper nipple hygiene should be taught to lactating mothers due to the increased risk of nipple cracks. Exclusive breastfeeding also helps to reduce the risk .
Mastitis is a common condition among breastfeeding women (puerperal mastitis or lactational mastitis). Its primary cause is bacterial although there are other causes. It is a painful condition and usually leads the mother to discontinue breastfeeding which may compromise infant nutrition and lead to hyponatremia. Mastitis is very rare in men .