Mastitis

Who gets it?

Breast infections are not as common as they used to be. Those who do get infections are:

• Neonates,
• Breast feeding women,
• Non-breast feeding women, and
• Women with diseases such as diabetes or rheumatoid arthritis which make them more susceptible to infections in general.

Terms 

• Mastitis: Mastitis is caused by a staphylococcus aureus infection (bacterial infection) due to milk stasis. This inflammation of the breast tissue is noted by diffused rending and swelling of the breast and skin.
• Abscess: collection of pus. This needs to be drained. Sometimes it can be done with a needle. Sometimes an operation is necessary.

Breast feeding mastitis

Breast feeding may lead to the nipple getting cracked and allowing infection to get into the breast. Mastitis is generalised infection of the breast tissue, which is usually caused by a staphylococcus aureus infection, but should the mastitis be bilateral, it is caused by a streptococcus infection.

Causes

One out of three lactating women has a chance of getting mastitis. Women with a history of mastitis with a previous child, nipple damage, and who use a manual breast pump, have a higher risk of getting the infection. Risk factors include inadequate milk drainage or prolonged separation from the baby, as well as damaged nipples (almost all damaged nipples are colonised with staphylococcus areus).

Symptoms

• a very swollen, tender breast,
• breast feeding may become painful, and
• a fever may be present.

It usually occurs in the first six weeks of breast feeding or during the weaning period.

Treatment

Mastitis is generally treated with antibiotics, but before starting antibiotics, women should consider up to 24 hours of conservative management – that is, rest, fluids, analgesics/antipyretics, frequent nursing and expressing of milk. Occasionally, an abscess may develop. If this occurs, it will require drainage, which may be done with a needle, or sometimes needs an operation. Breast feeding should continue until the infection settles down, as the infant will not harmed by the infection.

Prevention

Mastitis can be prevented by avoiding excessive intravenous fluids in labour, and by treating your damaged nipples with topical antibiotics.

Mastitis can be mistaken for breast cancer, candida mastitis, plasma cell mastitis, or a form of skin abnormality.

Other causes 

• Neonatal infections Occasionally, there may be a little bud of breast tissue present in a newborn baby and this, rarely, can become infected. Usually, the infection can be treated with antibiotics. Very rarely, a small operation may be necessary to drain the breast.
• Breast infections which are not associated with breast feeding These infections may be around the nipple or may be away from the nipple in the main part of the breast.
• Periductal mastitis means inflammation of the breast. This may be caused by infection or by irritation of the ducts from other causes.
• Duct ectasia means dilation of the terminal ducts of the breast. As a woman gets older, so her ducts dilate and become slightly “leaky”. Some of the fluid that is normally inside the duct can leak out and so cause the 'mastitis'.

In general, abscesses may be treated with needle drainage of the pus and antibiotics. Occasionally, this does not get rid of the complete infection and then an operation may be necessary. After this, the infection may get completely better or may go on to form a draining sinus. If this happens, an operation will be necessary to remove the underlying tissue.

Reviewed by Dr Anrich Burger General Physician MB ChB (Stell.)

The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.