Mastitis – Causes, Symptoms and Treatment
Mastitis is an inflammation of the breast tissue that most commonly occurs during breastfeeding. It causes pain, redness, and swelling of the breast and can be triggered by a bacterial infection.
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Mastitis is an inflammation of the breast tissue that most commonly occurs during breastfeeding. It causes pain, redness, and swelling of the breast and can be triggered by a bacterial infection.
What is Mastitis?
Mastitis is an inflammation of the breast tissue, typically affecting the mammary gland. It most commonly occurs in breastfeeding women – referred to as puerperal mastitis or lactation mastitis. A form that occurs independently of breastfeeding, known as non-puerperal mastitis, also exists. In rare cases, persistent mastitis-like symptoms may indicate a serious underlying condition such as inflammatory breast cancer, making medical evaluation essential.
Causes
The most common causes of mastitis include:
- Milk stasis: If the breast is not fully emptied during breastfeeding, milk can accumulate and trigger inflammation.
- Bacterial infection: Most frequently caused by Staphylococcus aureus, which enters the tissue through cracked or sore nipples.
- Blocked milk ducts: Can promote milk stasis and increase the risk of mastitis.
- Weakened immune system: Increases vulnerability to infection in breastfeeding mothers.
- Non-puerperal causes: Hormonal imbalances, smoking, diabetes mellitus, or chronic skin conditions can trigger mastitis outside of the breastfeeding period.
Symptoms
Typical signs of mastitis include:
- Redness, warmth, and swelling of the affected breast
- Intense, localized pain or tenderness
- Hardening or palpable lumps within the breast tissue
- General feeling of illness with fever (above 38.5 °C / 101.3 °F) and chills
- Headache, muscle aches, and fatigue
- In severe cases: purulent discharge from the nipple
Diagnosis
Mastitis is typically diagnosed clinically, based on the patient's medical history and a physical examination. Additional investigations may include:
- Breast ultrasound: To rule out a breast abscess (collection of pus) and assess the tissue.
- Laboratory tests: Blood count and inflammatory markers (e.g., CRP, leukocytes) to evaluate the severity of infection.
- Milk culture or swab: To identify the causative pathogen and determine antibiotic sensitivity.
- Biopsy or mammography: If symptoms persist or inflammatory breast cancer is suspected.
Treatment
General Measures
For mastitis during breastfeeding, it is generally recommended to continue nursing or to regularly pump milk to relieve the stasis. Cool compresses can help reduce pain and swelling.
Medical Treatment
- Antibiotics: In cases of bacterial mastitis, antibiotics are prescribed – commonly penicillins or cephalosporins, which are considered safe during breastfeeding.
- Pain relief: Ibuprofen or paracetamol can reduce pain and lower fever.
Treatment of a Breast Abscess
If a breast abscess (localized collection of pus) develops, it must be drained via needle aspiration or a small surgical incision. This procedure is typically performed under ultrasound guidance.
Non-Puerperal Mastitis
Treatment depends on the underlying cause. In addition to antibiotics, anti-inflammatory medications may be used for chronic forms, and surgical intervention may be necessary for abscess management.
When to See a Doctor
Medical attention should be sought promptly if fever exceeds 38.5 °C (101.3 °F), symptoms worsen within 24 hours, a firm and painful lump does not resolve, or purulent discharge occurs from the breast. Early treatment helps prevent complications such as abscess formation.
References
- Spencer J.P. - Management of mastitis in breastfeeding women. American Family Physician, 2008; 78(6): 727-731.
- World Health Organization (WHO): Mastitis – Causes and Management. WHO/FCH/CAH/00.13, Geneva, 2000.
- Amir L.H. - ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeeding Medicine, 2014; 9(5): 239-243.
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