Mastitis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Mastitis is an inflammation of the breast tissue that can involve infection. It most commonly affects women who are breastfeeding (lactational mastitis), but it can also occur in non-lactating women (non-lactational mastitis).

Aetiology

Lactational Mastitis: Usually caused by milk stasis or blocked milk ducts, which can lead to bacterial infection. The most common pathogens are Staphylococcus aureus and Streptococcus species.

Non-Lactational Mastitis: May be caused by conditions such as duct ectasia, diabetes, or trauma to the breast. Infection is less common but can occur, often involving similar bacterial species as in lactational mastitis.

Pathophysiology

The primary mechanism in lactational mastitis is milk stasis, where milk is not properly drained from the breast, leading to inflammation. Bacterial infection can develop if bacteria enter the milk ducts through cracks in the nipple. In non-lactational mastitis, inflammation may occur due to underlying conditions like duct ectasia, where dilated ducts become blocked and inflamed.

Risk Factors

• Lactational Mastitis: Incomplete emptying of the breast, infrequent breastfeeding, nipple damage, and poor latch.
• Non-Lactational Mastitis: Smoking, diabetes, nipple piercing, and trauma to the breast.

Signs and Symptoms

• Breast pain and tenderness, often localised to one area of the breast.
• Redness and warmth over the affected area.
• Swelling and hardness of the breast tissue.
• Fever and flu-like symptoms, particularly in cases of infection.
• Nipple discharge, which may be purulent in infected cases.

Investigations

• Clinical Diagnosis: Primarily based on history and physical examination.
• Breast Ultrasound: May be used to differentiate between mastitis and abscess, particularly in cases with significant swelling or when an abscess is suspected.
• Milk Culture: May be considered if the infection is recurrent or not responding to standard antibiotics, to identify the causative organism and tailor antibiotic therapy.

Management

• Primary Care:
  • Rest and Hydration: Encourage rest and increased fluid intake to support recovery.
  • Continued Breastfeeding: Advise continued breastfeeding or milk expression to ensure complete emptying of the breast.
  • Warm Compresses: Apply warm compresses to the affected area to help with milk flow and relieve pain.
  • Analgesics: Use NSAIDs or paracetamol to manage pain and inflammation.
  • Antibiotics: If bacterial infection is suspected, prescribe antibiotics such as flucloxacillin or erythromycin for those allergic to penicillin. Treatment typically lasts 7-14 days.
• Specialist Care: Referral to a breast specialist may be necessary if there is no improvement with initial treatment, if an abscess develops, or in cases of non-lactational mastitis that do not resolve with standard therapy. Ultrasound-guided aspiration or surgical drainage may be required for abscesses.

References

1. NHS (2024) Mastitis. Available at: https://www.nhs.uk/conditions/mastitis/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Mastitis: Assessment and Management. Available at: https://cks.nice.org.uk/topics/mastitis/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Diagnosis and Management of Mastitis. Available at: https://www.bmj.com/content/350/bmj.h4500 (Accessed: 24 June 2024).
4. American Academy of Family Physicians (2024) Management of Mastitis in Breastfeeding Women. Available at: https://www.aafp.org/afp/2024/0624/p4500.html (Accessed: 24 June 2024).

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