Definition
Mastitis non puerperalis is an inflammation of the breast that occurs outside of pregnancy and lactation. It occurs about as frequently as its counterpart (mastitis pueperalis), which is an inflammation of the breast during the breastfeeding period. Mastitis non puerperalis can be caused by bacteria, but also without the influence of external germs.
The inflammation is often located in the upper part of the outer breast. It manifests itself through pain, overheating and swelling of the breast, but usually does not cause fever. The therapy consists of cooling, nicotine withdrawal and, in case of a bacterial cause, antibiotic therapy.
Causes
If mastitis non puerperalis develops at the bottom of a bacterial inflammation, 40% of the germs are staphylococci. However, they are often mixed infections with different bacteria. Factors that favor a bacterial inflammation are piercings, smoking, taking the anti-baby pill with a high estrogen content and a recently expired breastfeeding period.
Galactorrhea, i.e. an outflow of breast milk outside the breastfeeding period, is still a common cause of infection. However, mastitis non puerperalis can also develop without the influence of bacteria, for example in benign breast diseases such as the secretion of breast milk outside the breastfeeding period, premenstrually painful breasts (mastodynia) or hormonally induced remodelling processes in the breast (mastopathy). Increased secretion of breast milk or similar fluids occurs. These accumulate within the milk ducts and milk is stored in the breast. The body recognizes this misplacement and triggers an inflammatory reaction, which leads to the symptoms described below.
Diagnosis
The diagnosis is made primarily on the basis of the clinical examination. The breast is systematically palpated with both hands, and in case of mastitis non puerperalis one can palpate rough, hardened tissue that can be easily distinguished from normal tissue. The hardening is caused by the storage of milk and the resulting inflammation with inflammatory edema.
Sonography (ultrasound) can be used to rule out an abscess, i.e. an encapsulated accumulation of pus. This is shown in the sonographic image with blurred boundaries and different echogenicity (recognizable in the image by different gray levels). Ultrasound is not suitable to see the inflammation in tissue.
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