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Mastitis

Parenchymatous inflammation of the mammary glands, or mastitis, occurs postpartum in about 1 % of lactating women, mainly in primiparas who are breast-feeding. It occurs occasionally in nonlactating women and rarely in men. The prognosis is good.

Causes

Mastitis occurs when bacteria infect your breast through a break or crack in the skin of your nipple or through the opening to the milk ducts in your nipple. Bacteria from your skin's surface and baby's mouth enter the milk duct and can multiply — leading to pain, redness and swelling of the breast as infection progresses.

Signs and Symptoms

Usually, the patient reports a fever of 101° F (38.3° C) or higher in acute mastitis, malaise, and flulike symptoms that develop 2 to 4 weeks postpartum, although they may develop anytime during lactation. Inspection and palpation may uncover redness, swelling, warmth, hardness, tenderness, nipple cracks or fissures, and enlarged axillary lymph nodes.

Diagnostic tests

Cultures of expressed milk are used to confirm generalized mastitis; cultures of breast skin are used to confirm localized mastitis. Such cultures also are used to determine antibiotic therapy. Differential diagnosis should exclude breast engorgement, breast abscess, viral syndrome, and a clogged duct.

Treatment

Antibiotic therapy, the primary treatment, usually consists of penicillin G to combat staphylococci; erythromycin or kanamycin is used for penicillin-resistant strains. A cephalosporin or dicloxacillin is also used. Symptoms usually subside in 2 to 3 days, but antibiotics should continue for 10 days. Other measures include analgesics and, rarely, breast abscess incision and drainage.

Prevention

Sometimes mastitis is unavoidable. Some women are more susceptible than others, especially those who are breastfeeding for the first time. In general, good habits to prevent mastitis include the following:

  • Breastfeed equally from both breasts.
  • Empty breasts completely to prevent engorgement and blocked ducts.
  • Use good breastfeeding techniques to prevent sore, cracked nipples.
  • Avoid dehydration by drinking plenty of fluids.


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