Mastitis

Breastfeeding and lactation are the most likely causes of mastitis Breastfeeding places stress on the nipple and surrounding breast tissue, which often results in small skin cracks. Bacteria from the baby's mouth or the mother's skin may enter these abrasions and infect breast tissue.

Mastitis is an inflammation of the breast tissue and may or may not be accompanied by infection

If milk is not removed from the breast, pressure in the alveoli rises to the point where milk substances are forced into the surrounding tissues

Mastitis affects the breast's parencyhmal, or fatty, tissue. Tissue inflammation presses on the breast's milk ducts, altering milk flow and causing pain

The true incidence of mastitis is unknown:

1. Figures of up to 33% have been quoted.

2. The incidence is generally accepted as being less than 10%

Plugged milk ducts during lactation may also cause a breast infection. An erratic nursing schedule or missed feedings can cause breast engorgement, in which the breast fills with unused milk. This in turn can cause milk to stagnate and milk ducts to plug, creating a breeding area for mastitis-causing bacteria

External pressure on the breasts during lactation also increases the chances of developing plugged milk ducts and breast mastitis. Tight clothing or ill-fitted bras can restrict milk flow and make breast infections more likely

Other objects or activities that can compress breasts and cause mastitis while breastfeeding include baby carriers breast pads excessive exercise heavy diaper bags and purses mopping mowing the lawn

nipple shields raking leaves shoveling snow swimsuits vacuuming

Towards the end of lactation, abruptly ceasing breastfeeding can cause a period of breast engorgement and increases the risk of mastitis. Using bottles and pacifiers during breastfeeding can alter how an infant suckles, making small cracks and abrasions in the breast more likely

Symptoms of Mastitis

The main symptoms of mastitis are breast pain, swelling, redness, and fever. Generally, a breast infection affects only one breast. Breast enlargement, due to swelling and milk engorgement is also common during mastitis.

Mastitis may change nipple sensation, or result in nipple discharge with pus from the infection. Sensations of heat, itching, and tenderness may be felt in affected areas of the breast; these feelings result from an inflammatory immune reaction to the mastitis

The most alarming symptom of mastitis is the presence of a breast lump. The lump is composed of swollen and inflamed breast tissue, which may develop into a breast abscess. As most women associate breast lumps with cancer, the initial reaction to a mastitis lump or breast abscess often includes anxiety and fear

FREQUENT SIGNS & SYMPTOMS

Symptoms may occur anytime while nursing, but usually begin 3 to 4 weeks after delivery. Common symptoms include:

Fever, malaise (flu-like symptoms).

Tender, swollen, hard, hot breast(s).

Sometimes nausea and vomiting

Mastitis infection is often caused from bacteria that enter the mother's breast from the nursing baby's nose or throat. The most common bacteria are Staphylococcus aureus and beta-hemolytic streptococci. Infection with the mumps virus is another cause

Risk Factors for Breast Infections

Smoking while breastfeeding increases the risk of breast mastitis. Smoking hinders the breasts' milk ejection reflex, raising the risk of breast engorgement and plugged milk ducts. Fatigue, anemia, and stress all increase a woman's chance of developing a breast infection during lactation

Anatomical defects and surgical scars may also increase the risk of breast infection during lactation. Surgical scarring from a breast biopsy, cosmetic surgery, breast tumor removal, cyst removal, or breast abscess scars may all interfere with milk flow.

Women with fibrocystic breast disease may have a slightly higher risk of breast mastitis than those with "normal" breasts

Treating Breast Mastitis

Bacteria are usually the cause of mastitis during breastfeeding. The bacterial strains staphylococcus and streptococcus are the most common breast infection causes. The standard treatment for breast infection is antibiotic medication

DIAGNOSTIC TESTS

Diagnostic tests may include laboratory blood studies, culture of pus or fluid, and, occasionally, ultrasound, mammography, and breast biopsy if something other than infection may be causing symptoms.

INFANT THROAT CULTURE Occasionally, baby can have the bacteria in the back of his throat and be reinfecting mom with mastitis. This can be determined by swabbing the baby's throat. If the culture is positive, then baby should be treated along with mom. A culture of your milk can also help your health care provider better determine the best treatment (antibiotic-wise)

BREASTMILK CULTURE Any time a lactating woman with mastitis symptoms has a fever for more than twenty-four hours she should contact her health care provider because she may need antibiotics in addition to the suggestions given below.

Cultures of the breast milk should be taken after the breast has been cleansed with water and the mother's hands have been thoroughly washed. The milk stream should be initiated by manual expression and the first three milliliters discarded to get a midstream clean-catch specimen

If mastitis symptoms do not improve within a day of starting antibiotics, it is possible the breast infection is a yeast infection, and not caused by bacteria. Yeast infections may pass to the breast from the mother's skin, or from a thrush infection in the baby's mouth

Self Care and Breastfeeding with Mastitis

An episode of mastitis during lactation may make a woman wonder if she should continue breastfeeding. The answer, usually, is yes. Continuing breastfeeding and expressing milk prevents breast engorgement and milk stagnation, both of which can worsen mastitis symptoms

Mastitis during lactation presents little danger of infection to a suckling infant. The infection is not likely to pass to the baby through milk, and it may well be that the infant already had the infection, and passed it to the mother during breastfeeding

A breast infection increases the amount of sodium in the affected breast's milk, and infants may prefer feeding at the other breast. Feeding the baby from the infected breast first helps maintain normal breastfeeding habits. If the infant refuses to take enough milk from the mastitis infected breast, excess milk should be expressed to prevent breast engorgement

Self-care during a bout of mastitis can help alleviate symptoms and reduce the risk of a breast abscess or further breast infection. Applying a moist hot compress to the affected breast for fifteen to twenty minutes four times a day can help reduce mastitis pain. Some women gain relief from breast infection pain by expressing milk in a hot shower

Breast Abscess and Other Mastitis Complications

A severe case of breast infection may develop into a breast abscess. A breast abscess is an area of infected breast tissue filled with pus, dead cells, and fluid. A breast abscess can press upon milk ducts, causing lactation problems and pain

There are two types of Mastitis:

1. Cellulitis - which involves an infection of the connective tissue.

2. Adenitis - which is an infection in the milk duct

A breast abscess could develop if mastitis is not treated properly. This is rare but has been treated without cessation of breast-feeding. The abscess is a lump that remains after mastitis and after nursing. It may be hard or soft and needs to be drained surgically

Antibiotics will be prescribed and mother may have to pump on the affected side while it heals. Then resume nursing both sides. Remember to watch for signs of yeast infections with antibiotic use. Eating yogurt while taking antibiotics may prevent yeast infections

A breast abscess can be treated by draining the abscess with a fine needle. If necessary, the abscess can be surgically removed through a breast incision. Women planning future pregnancies should be aware that surgical scarring increases the risk of mastitis during future lactation and breastfeeding

It is possible for women to experience recurrent mastitis throughout lactation, a condition that disrupts breastfeeding and increases the risk of a breast abscess. In some cases, ceasing breastfeeding and ending lactation may be necessary to prevent further breast infection

Some doctors treat chronic breast infection during breastfeeding with prophylactic antibiotics. In other cases, breastfeeding women watch carefully for signs of plugged milk ducts and/or flu-like symptoms, and report such symptoms promptly

Breast Infection When Not Breastfeeding

Mastitis rarely develops outside of lactation. Women who do develop breast infection or abscess symptoms when not breastfeeding may require breast biopsies to rule out a rare type of breast cancer than mimics mastitis symptoms

Women who are breastfeeding usually do not undergo biopsy tests during mastitis or abscess diagnosis, but may require skin biopsies if antibiotic and antifungal treatments prove ineffective