What is Mastitis?
Mastitis is an inflammation of the breast tissue that most often occurs during the early stages of breastfeeding but may occur at any time. Mastitis can develop in women who have not recently delivered, in addition to women after menopause. Mastitis infection typically occurs in one breast.
If mastitis is not treated, a more serious breast infection, called an abscess, can develop. An abscess may require surgical drainage to remove pus from the breast.
What Causes Mastitis?
Mastitis can be caused by allergy, obstruction, or infection. Infectious mastitis occurs when bacteria enters the milk duct of the breast through an abrasion or crack in the nipple. These bacteria multiply rapidly within the breast tissue and can lead to:
1) Superficial small infections generally caused by streptococcal bacteria.
2) Larger, deeper, walled-off infections or abscesses generally caused by staphylococcal bacteria.
Who Gets Mastitis?
- 10-30% of breastfeeding women
- Women with Diabetes or other chronic illnesses
- Women with AIDS or other immune-weakening conditions
- (Rarely) Women with an inflammatory carcinoma
What is Chronic Mastitis?
Chronic mastitis occurs in women who are not breastfeeding. In some women, after menopause, mastitis can be associated with chronic inflammation of the ducts below the nipple. Hormonal changes can cause these milk ducts to become clogged with dead skin cells, which make the breast more prone to infection. Chronic mastitis often returns after antibiotic treatment.
Chronic mastitis may also occur in women who are prone to mastitis due to ongoing immune system deficiencies.
Causes and Risk Factors Associated with Mastitis in Breastfeeding Women:
- Infrequent or decreased nursing
- Insufficient milk removal from the breast due to poor latch or insufficient pump
- Introduction of bacteria to the ducts due to abrasions or cracks, often due to poor latch
- Ill-fitting or underwire bra, restrictive clothing, long hours under tight seat belt
- Recent illness and/or compromised immunity
- Untreated milk duct blockage/plugged duct
- Maternal fatigue and/or illness
Symptoms of Mastitis:
Mastitis can cause redness, pain, swelling, and warmth in the breast along with any number of these symptoms:
- Fever of 101 degrees or higher
- Flu-like symptoms
- Red streaking on the breast, which indicates spread of infection
- Breast engorgement
- Difficulty expressing milk or pain during expression
- Body aches
- Fever and chills
- Tenderness, swelling, painful lumps in the breast
Symptoms of Breast Abscess:
Occasionally, a breast abscess complicates mastitis. These abscesses are generally more painful and can be felt underneath the skin. These symptoms may indicate an even more serious infection of the breast that requires immediate medical attention:
- Pus drainage from the nipple
- Persistent fever without improvement of symptoms within 2 to 3 days after treatment
- Tender mass in the breast that does not diminish after breastfeeding
Diagnosis Of Mastitis:
A physician will perform a physical exam of the affected breast and review the patient's symptoms in order to diagnose the condition. If the patient has a fever and is showing signs of infection, an antibiotic may be prescribed. In some cases, cultures may be taken (from breastmilk or via aspiration) to determine the type of microbe causing the infection. This can help to ascertain which antibiotics would work best, especially in cases where an abscess is present.
If a woman develops mastitis while not nursing or is unresponsive to antibiotic treatment, a mammogram or breast biopsy may be performed to rule out a rare type of breast cancer.
Treatment for Mastitis:
Mastitis can often be treated from home in the early stages; however, the situation should be monitored closely. It is always a good idea to seek medical care and instruction.
Here are some home care tips for mastitis:
- Frequent nursing – keep breast as empty as possible - and massage breast while nursing.
- Use nursing positions to aid in milk drainage, such as "dangle feeding" where you kneel over the baby while nursing.
- Bed rest - stay in bed as much as possible until all signs of illness are gone.
- Use painkillers like Tylenol or ibuprofen, which will help with the pain and are considered safe for breastfeeding.
- Warm (as warm as you can stand) compresses. A cloth diaper works well while a disposable diaper can hold heat in for longer – some also use a ThermaCare wrist-wrap type compress.
- If heat is ineffective in pain relief, try ice packs on the breast (but avoid using ice packs just before nursing as the ice may slow down milk flow).
- Take hot showers and massage breast towards nipple.
- Hand express or pump after nursing to empty breast.
- Drink plenty of fluids - at least ten glasses each day.
- Loosen clothing, go bra-less or topless.
- Cabbage leaves over the breast may be used to reduce inflammation – discard leaf when wilted – helps draw out the infection and can bring some relief to swollen, painful breasts; however, be careful of cabbage if milk supply is an issue for you as it may decrease supply.
If symptoms have been present for more than 24 hours and are not improving with self-care or are causing acute illness, your physician may prescribe antibiotics to fight infection.
When To Go To The Doctor:
Most cases of mastitis are not due to infection; however if left untreated, infection can set in and illness can quickly progress. If self-care does not improve symptoms in 12-24 hours, if symptoms worsen, or if any of the following occur, seek medical care:
- Pain that is not manageable
- Dizziness, fainting, and confusion
- Persistent fever greater than 101.5 degrees
- Pus drainage from the nipple
- Red streaks extending to the arm or chest
- Nausea and/or vomiting that prohibits you from taking your antibiotics
Additional Mastitis Resources:
An excellent resource for all things breastfeeding is Kelly Mom, and the Plugged Ducts and Mastitis page is extremely helpful in helping to determine when to seek medical care and how to treat yourself at home.
La Leche League International is another site devoted to helping mothers breastfeed their babies. The site provides many articles on a multitude of breastfeeding related topics.
The International Lactation Consultant Association provides a directory to assist in locating an International Board-Certified Lactation Consultant to help get through breastfeeding difficulties.