Conditions

Mastitis is the medical term used for the presence of infection or inflammation or both in the breasts. The infection takes place in the parenchymal tissue of the breast.

Alternative names

Infection of breast tissue

Definition

  • Mastitis is the medical term used for the presence of infection or inflammation or both in the breasts.
  • The infection takes place in the parenchymal (fatty) tissue of the breast.
  • There are two types of mastitis, acute or chronic. Though both cause inflammation, pain and tenderness in the breast they have different causes. 

Chronic mastitis

  • This is usually a discrete lump in the breast. There may be a discharge from the nipple and it tends to get worse when the patient is pre-menstrual.

Acute mastitis

  • Mastitis which occurs in breastfeeding women.
  • It occurs when bacteria gets into the breast.
  • Mastitis can masquerade as breast cancer, candida mastitis, plasma cell mastitis or a form of skin abnormality.
  • Women with diseases such as diabetes or rheumatoid arthritis are at a higher risk for infections and are thus at a higher risk to develop mastitis.
  • It can also appear in newborn babies.

For purposes of this article, causes, treatment and prevention of mastitis will be discussed in view of breastfeeding mastitis.

Causes of breastfeeding mastitis

It usually occurs in the first six weeks of breastfeeding or during the weaning period of a baby from breast milk to solids.

Possible causes include:

1. Bacteria

  • Infection occurs through a crack or sore in the nipples. The bacteria get into the milk ducts of the breast and causes infection.
  • There are two types of bacteria which can infect the breast tissue:
  • Staphylococcus aureus (staph infection)
    •  Usually appears in only one breast and is called unilateral mastitis (one-sided)
    • Streptococcus infection (strep infection)
    • May appear in both breasts and is called bilateral mastitis.

2. Milk stasis

    Milk stasis is a back-up of milk in the breast and may increase the risk of developing mastitis.

    Conditions that increase milk stasis are:

  • Restrictive breastfeeding
  • Poor positioning and latching which inhibits milk drainage
  • Overabundant breast milk supply (engorgement) - excessive fullness of the breast. Usually beginning between two days and a week after childbirth, when a mother starts lactating. Symptoms usually disappear in a few days when nursing is well-established, but breasts can re-engorge during weaning, or a sudden stop in breastfeeding.
  • Sudden reduction in breastfeeding. An increase in supplemental (formula) feedings, pacifier use, or use of solid foods would also result in a reduction of breastfeeding.

3. Blocked milk duct (non-infective mastitis)

  • A blocked duct can feel like a pea-size lump within your breast (under your skin) and is sore or painful to the touch
  • A blocked milk duct can cause the same symptoms as mastitis, but without infection.
  • A blocked milk duct will usually clear within 1 - 2 days and symptoms will then go away.
  • However, in some cases a blocked milk duct becomes infected and develops into mastitis.

4. Other causes:

  • History of mastitis: Women with a history of mastitis with a previous child, nipple damage and the use of a manual breast   pump, have a higher risk of getting mastitis.

Symptoms

  • Flu-like symptoms
  • Mastitis often starts in a section of breast near to the nipple
  • Breast enlargement may occur or a breast lump may be felt
  • Fever (high temperature) may also develop
  • Painful, itchy, swollen, red and tender breasts
  • Areas of hardness on the breast
  • Breastfeeding may become painful
  • Tender lymph nodes in the armpit on the same side

Diagnosis 

  • Tests are usually not necessary as the physical signs and symptoms might be enough for your doctor to diagnose mastitis.
  • In women who are not breastfeeding, testing may include a mammogram or a breast biopsy.

Treatment

  • A warm wet facecloth before you breastfeed can soothe the swelling and it will stimulate the flow of milk.
  • A cold cloth will also help reduce the pain between feedings.
  • Continued breastfeeding or expression of milk will keep the milk to flow and to drain the infected tissue. (It is safe for both moms and babies to continue breastfeeding through mastitis)
  • Antibiotics may be prescribed in severe cases. If antibiotics are necessary, the doctor can prescribe an antibiotic that is compatible with breastfeeding so you can continue to breastfeed your baby safely. The infection will usually clear within a few days once you start the antibiotic.
  • Mild cases of mastitis may go without any antibiotic treatment.
  • Your baby may refuse to feed from the affected breast as the taste of the milk may change a little. If this occurs, feed from the other breast. However, express the milk from the affected breast to keep the milk supply going

Speak to your doctor about pain relief / symptom relief medication.

Prognosis

The condition usually clears quickly with antibiotic treatment.

Complications

  • Untreated cases of mastitis can result in a serious abscess which may need to be treated with surgery to drain it.
  • An abscess is a collection of pus which causes a firm, red, tender lump.

When to call your doctor

You should see your doctor if you show any signs of mastitis, a blocked milk duct or if your lymph nodes are swollen.

Prevention 

  • Proper breast care during breastfeeding is an important part of preventing mastitis. Treat damaged nipples with topical antibiotics (ointment / cream).
  • Breastfeed frequently. Don't restrict the length of feedings.
  • Breastfeeding should not be stopped suddenly; a baby should be weaned of the breast slowly.
  • Relieve engorgement promptly. Milk that doesn't flow gets thicker and clogs the ducts, which is a set-up for mastitis.
  • Consult a breastfeeding consultant to work out a breastfeeding plan or a plan for weaning.

Further publications on the topic