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Mastitis

Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier

Mastitis means inflammation of the breast. In the majority of cases it is caused by milk stasis, not infection, although infection may supervene. Typically one or more adjacent segments of the breast are inflamed and appear as a wedge-shaped area of redness and swelling. In some cases, flu-like symptoms, including shivering and/or rigors, may occur.

Acute inflammatory mastitis

This may occur during the early days of breastfeeding as a result of unresolved engorgement or at any time when milk from one or more segments of the breast is not removed efficiently by the baby. It occurs most frequently in the breast opposite the mother's preferred side for holding her baby. It is important to continue feeding from the affected breast to avoid further milk stasis, providing ideal conditions for pathogenic bacteria to replicate.

Infective mastitis

The main cause of superficial breast infection is damage to the epithelium, which allows bacteria to enter underlying tissues. This can result from incorrect attachment of the baby to the nipple. The mother will require help to improve her technique, as well as appropriate antibiotic therapy. Infection may also enter the breast via the milk ducts if milk stasis remains unresolved. In spite of antibiotic therapy, abscess formation may occur.

Breast abscess

A fluctuating swelling develops in a previously inflamed area. Pus may be discharged from the nipple. Simple needle aspiration may be effective or incision and drainage may be necessary. It may not be possible to feed from the affected breast for a few days but milk removal should be continued and breastfeeding should recommence as soon as practicable to reduce the chances of further abscess formation.

Further reading

Harding M (2015). Puerperal mastitis (Professional reference). Available at: http://patient.info/doctor/puerperal-mastitis

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