Introduction
Inflammation of the mammary glands during lactation is also called mastitis puerperalis. By definition, it occurs exclusively during breastfeeding, whereas mastitis outside the breastfeeding period is called mastitis non puerperalis. It is an acute inflammation of the glandular tissue of the breast, caused by a congestion of milk secretion or an infection with bacteria. It often occurs about two weeks after delivery and can be diagnosed by clinical examination or ultrasound. The therapy depends on the cause and ranges from simple cooling of the area to antibiotic therapy.
Causes
The inflammation of the mammary gland can be caused in two ways. On the one hand, an infection with a bacterium can trigger the described clinical picture. The most common is an infection with staphylococci.
These are transmitted by the mother or hospital staff to the nasopharyngeal cavity of the infant due to lack of hygiene measures, which in turn brings the bacteria close to the mother’s breast during breastfeeding. The pathogen can either enter the milk ducts directly via the nipple and cause an inflammation there, or it can enter the lymphatic flow area via the smallest injuries to the breast and cause the inflammatory reaction from there. In addition to the infection, a congestion of the milk secretion can also lead to an inflammation of the mammary gland, as the secretion accumulates in the milk ducts and can trigger an inflammation with pain and hardening. Reasons for the accumulation of milk secretion are insufficient emptying of the breast during breastfeeding, increased swelling of the mammary glands after delivery with the result that the breast can only be emptied with difficulty or an insufficient milk donor reflex when the baby is attached to the breast, which can be disturbed by pain or stress, for example.
Diagnosis of inflammation of the mammary gland during lactation
The diagnosis of mastitis is usually made by a clinical examination. Attention is paid to the typical local signs of inflammation (see accompanying symptoms), which are often associated with fever. Palpation or ultrasound may be helpful in differentiating whether the inflammation of the mammary gland is an initial stage with diffuse inflammation (phlegmon) or already an advanced stage with encapsulated inflammation (abscess). An abscess is palpated as a circumscribed mass that can be easily pressed in. In the ultrasound, the abscess appears as a dark, almost black mass, while a diffuse inflammation does not show typical signs in the ultrasound.
Associated symptoms of mastitis
Mastitis is characterized by local redness, swelling and overheating of the affected area. In addition, it is possible to palpate hardenings that can be so painful that an examination of the breast is hardly possible. The pain and swelling continue to make it difficult to breastfeed or pump out the milk secretion, which is an important part of the therapy. A swelling of the lymph nodes in the armpit on the same side is also typical. In contrast to mastitis non puerperalis, inflammation of the mammary glands during breastfeeding is regularly accompanied by fever > 38°C and a pronounced feeling of illness.
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