Breast inflammation or mastitis is an inflammatory disease of the breast or nipple. Most often, mastitis occurs during breastfeeding after pregnancy. However, male breasts can also become inflamed or sore due to rubbing of improper clothing, for example, during jogging. However, in this article we are dedicated to breast inflammation during breastfeeding in women.
What is mastitis?
Mastitis or breast infection is an infection of the female mammary gland caused by bacteria, which usually spreads through tiny skin lesions. The much more common mastitis during breastfeeding (mastitis puerperalis) is distinguished from the independent form (mastitis non puerperalis). Approximately one in 20 breastfeeding women is affected by this condition.
Causes
Mastitis usually occurs unilaterally and is most common by day 28 postpartum. The ports of entry in nursing mothers are usually small skin lesions of the nipple, which result from the infant’s sucking. Bacterial colonization occurs and finally infection by typical skin germs (mostly by Staphylococcus aureus), which are found in the infant’s mouth. Incorrect attachment techniques, sore nipples, but also a milk stasis have a favorable effect. The rare non-puerpura mastitis is also triggered by small skin lesions. Hormonal disorders, metabolic diseases and certain medications promote its development. Breast cancer must always be ruled out in this form, as it can have an identical clinical appearance.
Symptoms, complaints, and signs
A number of symptoms may occur with mastitis. Typically, there is an extended sensation of pain and tightness, usually accompanied by a hardening of the breast. The affected breast is also reddened and swollen. Overheating of the breast can also be observed. This is often accompanied by a sudden fever, which manifests itself as acute circulatory problems, sweating and an increasing feeling of illness. In the case of mastitis outside the breastfeeding period, the above-mentioned symptoms usually occur in a weakened form, but may recur. If the symptoms occur during breastfeeding, they are more intense, but usually occur only once. The development of recurrences is relatively unlikely. In individual cases, however, mastitis can lead to the development of purulent encapsulated abscesses. In the most severe cases, fistulas can develop from these, through which pus and other fluids can reach the tissue and other organs or the skin. On the basis of these symptoms and complaints, mastitis can be clearly diagnosed. In the absence of treatment, the swelling usually increases in size, but subsides on its own after one to two weeks at the latest.
Course
At the beginning of mastitis, there is usually unilateral pain in the area of the nipple. Fever above 38.5 degrees Celsius, chills, and fatigue are added as signs of infection. On the breast, redness and hyperthermia, possibly an eczema-like rash, are indicative. The milk changes and sometimes has bloody or purulent admixtures. If the breast infection is pronounced, the lymph nodes in the armpit are swollen and painful. Abscesses (encapsulated accumulations of pus) can occur as complications in untreated mastitis. These show up as a palpable swelling under the skin that typically feels gelatinous.
Complications
Several complications can occur in association with mastitis. If mastitis is treated incorrectly or too late, well-defined collections of pus called abscesses can form. If the abscesses do not empty themselves, they must be opened surgically. If abscesses are not treated, channels can form between the abscess and the skin – so-called fistulas. Fistulas, in turn, can be entry points for bacteria. In severe cases, this can lead to blood poisoning (sepsis). Chest inflammation is often also associated with pain, a feeling of tightness, redness and swelling. A feeling of warmth and pain in the nipple area may also be associated with mastitis. Lymph nodes may swell in the armpits. Thickening of the breast is also possible.Other complications associated with mastitis may include fever, malaise and chills. Affected women feel tired, fatigued and sick. Mothers with mastitis may have trouble breastfeeding. Milk may become engorged, the breast is engorged and painful. As a result, the flow of milk becomes more difficult. Breast inflammation can recur outside of breastfeeding and can also be chronic.
When should you go to the doctor?
In the case of mastitis, prompt clarification of the symptoms of the affected woman by the attending gynecologist or a supervising midwife is important. This applies to both the mastitis within and the variant outside the breastfeeding period. If the mastitis is triggered by breastfeeding, it is a trigger that is still maintained for a longer period of time, not least at the request of the woman. However, in order to enable the mother to breastfeed several times a day, even in the case of mastitis, without great pain if possible, an early visit to the doctor or, alternatively, to the midwife is recommended. Both professional groups are professional contacts who can recommend suitable therapies to the woman that make breastfeeding possible and do not pose a risk to the baby. Breast inflammation outside the breastfeeding period also justifies a quick visit to the gynecologist. This is especially true if the symptoms such as redness, swelling and pain are severe, increasing or persistent, or if they are accompanied by fever or a clear feeling of illness. In this case, it is not only important to treat the often very unpleasant symptoms of mastitis at the doctor’s office. It is also important to rule out inflammatory breast carcinoma, as this variant of breast cancer manifests itself similarly to mastitis and requires immediate treatment because of its rapid progression.
Treatment and therapy
According to recent studies, weaning is not necessary for mastitis. This measure should also be rather an exception, since a weaning represents a strong burden for the women and can partly even delay the course of the disease as well as the healing. If the baby is put on correctly, it can release a build-up of secretions by sucking and thus accelerate healing. Medicinal therapy with antibiotics should be given. If the antibiotic is chosen appropriately, harm to the baby from the medication is unlikely if breastfeeding continues. The clinic was also unable to determine any danger to the breastfed child from the infection itself. If an abscess has already developed, drug therapy is no longer sufficient. As a rule, the abscess must be opened surgically. In addition, further pus drainage should be ensured, e.g., via a rubber flap. The wound cavity must heal from below to prevent the abscess from forming again. Supplementary irrigation with antibiotic or antiseptic solution can be performed. Painkillers are used to relieve the pain, especially so-called NSAIDs (e.g. diclofenac), which are harmless to the child and also have an anti-inflammatory effect. Bed rest and adequate sleep are also useful. Cooling measures are also used successfully; in addition to cool packs, curd or cabbage compresses are also very gentle and long-lasting effective. Breast inflammation during breastfeeding is a very common condition in a sensitive area. Women are faced with many fears, such as whether the treatment will harm the child or whether they can continue to feed their child naturally. Therefore, in addition to the actual therapy, good psychological support from the doctors and midwives is an important building block for recovery.
Outlook and prognosis
The healing prospect of mastitis is good. In many cases, it resolves on its own within a few days if the mammary gland and nipple are rested. Supportive soothing ointments can be applied to the breast to shorten the healing process. In most patients, mastitis is diagnosed during breastfeeding. Due to the overuse of the mammary gland, inflammation often occurs. With medical treatment, the inflammation recedes completely within a few days or weeks. It is also helpful to change the breastfeeding technique used in order to reduce the risk of the mastitis returning during the breastfeeding period.If mastitis occurs outside of breastfeeding, the likelihood of recurrence is increased many times over. In addition, there is a risk that it will turn into chronic mastitis. If a purulent fistula or abscess forms during inflammation, surgical intervention is performed. In this case, the tissue changes are removed from under the skin or drained inside the mammary gland, as well as medically treated. The risk of complications or other diseases is significantly increased in smokers and people with a weakened immune system. There is a prolongation of the healing process or the transition to chronic mastitis is facilitated by the battered state of health.
Follow-up
Mastitis exists within and outside of breastfeeding. Due to the diverse causes of the two variants, the aftercare is also somewhat different. For mastitis during breastfeeding, aftercare also means finding the right time to start breastfeeding again or to stop breastfeeding. This is where midwives and gynecologists, as well as lactation consultants, are the right people to talk to. In addition, both breasts should be used alternately for breastfeeding or, if only one breast was affected by the inflammation, it should be increasingly spared. If the inflammation arose outside the breastfeeding period, it is important to prevent pathogens from entering through the nipple or skin tears by practicing good hygiene, as far as this is possible. Strengthening the immune system can also prevent the mastitis from recurring. This includes adequate sleep and a healthy diet. In both cases of mastitis, it is advisable to wear a well-fitting bra. It reliably supports the affected tissue and is especially important in the phase of regeneration and aftercare to prevent the inflammation of the breast from flaring up again. The bra can also be worn during sleep. However, models with underwires, which could negatively affect tissue due to pressure, should be avoided and a softer variant should be chosen instead.
What you can do yourself
If breast inflammation is suspected, affected persons should consult a gynecologist immediately. Depending on the severity of the disease, antibiotic therapy is given or an attempt is made to reduce swelling of the mammary glands by relieving the pressure and cooling. If antibiotics are used for treatment, probiotics should be taken at the same time, as the medication also destroys the healthy intestinal bacteria and thus places a greater strain on the immune system. Often the mastitis occurs during the breastfeeding phase. If streptococci are the cause of the disease, a break from breastfeeding should be taken. Otherwise, mothers can continue breastfeeding as usual. In the periods between breastfeeding, cooling quark compresses and compresses with antibacterial plant extracts such as sage are recommended. The female breast can also be relieved by a tight-fitting bra and regular emptying – by expressing or pumping – of the breast. This reduces the pressure in the inflamed mammary glands. To prevent further breast inflammation caused by breastfeeding, mothers should ask a midwife to show them various techniques. Likewise, the baby’s mouth and nipples should be cleaned with warm water before breastfeeding to reduce the number of bacteria. Certain medications can increase the risk of mastitis. These include contraceptive preparations and those used to relieve menopausal symptoms, which contain high levels of estrogens. A change of medication should be discussed with the attending gynecologist.
