Inflammation of the breast is an inflammation of the mammary gland of the nipple and / or the mammary glands. Specialists distinguish puerperal mastitis, extra-puerperal mastitis and neonatal mastitis. What are the causes and symptoms of mastitis? How is the treatment going?
Inflammation of the breast( mastitis ) is mostly associated with breastfeeding, as 95 percent of breastfeeding cases are puerperal mastitis( mastitis puerperalis ). The remaining 5 percent arepostpartum mastitis( mastitis nonpuerperalis ),neonatal mastitis( mastitis neonatorum ) and Montgomery's abscess. Inflammation of the breast can take the form of inflammation of the nipple ( thelitis ) and / or inflammation of the mammary glands ( mastitis ). The first signs of inflammation of the breasts are breast pain, redness, swelling and increased local heat. Inflammation of the breast in men is very rare. If treatment is unsuccessful, a histopathological examination is performed to rule out breast cancer, and in the case of nipple inflammation, Paget's cancer is performed.
Puerperal mastitis: causes, symptoms, treatment
Puerperal mastitis ( mastitis puerperalis ) usually occurs between 2 and 6 weeks postpartum, although it can develop at any time during lactation. The puerperal mastitis lasts on average 3-4 days, with the second day being the most difficult. Proper treatment reduces the fever after about a day, and the pain and swelling disappear within 48 hours.
Puerperal mastitis is most often caused by staphylococcus aureus ( Staphylococcus aureus ), but it can also be caused by cutaneous staphylococcus ( Staphylococcus epidermidis ), streptococci β-hemolytic from groups A and B, colon bacteriaE. coli , as well as fungi (yeasts). But first there must be a situation that will open the way for them and facilitate their colonization.
So what is conducive to the development of inflammation? First of all, food stagnation, incomplete breast emptying, reduced feeding frequency, breast trauma, overproduction of milk due to unnecessary pumping, improper nutrition, nipple damage, incorrect feeding technique,reduced body immunity, previous breast inflammation.
There are two types of puerperal mastitis:
- adenitis- when infection occurs after clogging of the milk duct or food stagnation, and if an inflammatory encyst is allowed, an abscess will form
- cellulitis- the damaged skin of the nipple leads to the bloodstream infection of the connective tissue of the breast gland
The first symptoms of puerperal mastitis are usually breast pain (localized in one place), local reddening of the skin and low-grade fever. Additionally, the infected area is warmer and shows tenderness and pain on palpation. Over time, a high fever appears, redness, swelling and pain worsen, as well as chills, bone pain, headache and increased heart rate (tachycardia).
Puerperal mastitis most often affects the outer upper quadrant of the breast, although it can extend to the entire breast.
According to WHO guidelines, when after two days of empiric antibiotic therapy (administration of a broad-spectrum antibiotic) there is no improvement, the inflammation is recurrent, or has occurred in hospital or is extremely severe, milk should be tested and determined antibiogram.
Worth knowingIf you want to avoid puerperal mastitis, you should:
- in the third trimester to temper the breasts
- prevent any damage to the nipple
- in case of cracks, use the ointment after each feeding
- avoid wet compresses for cracks as they favor the maceration of the epidermis
- stop feeding for 1-2 days if the cracks are deep and express the milk during this time
In the initial stage (the first day after the onset of symptoms), it is sometimes enough to properly and regularly latch the baby to the breast (or use a breast pump if the baby sucks too little), cold compresses on the breast, plenty of fluids and rest. However, if there is no significant improvement within 24 hours from the onset of the first symptoms, it is essential to see a doctor.
If you do not want to worsen your condition, do not massage or knead your breasts, and do not use hot compresses.
Usually, quick administration of antibiotics, painkillers prescribed by a doctor, regular latching of the baby to the breast and cold cabbage compresses quickly solve the problem. Secretion-inhibiting drugs can be used to treat puerperal mastitisprolactins, and thus lactation-inhibiting, such as bromocriptine. However, if you want to continue breastfeeding, you can opt out of them after consulting your doctor and lactation advisor.
When treating puerperal breast inflammation, strictly follow your doctor's instructions to avoid relapse, which is the most common complication of this condition. Not less often there may be a reduction in the amount of food, so it is worth using the support of a lactation advisor. The most serious complication of puerperal mastitis is a breast abscess.
Postpartum mastitis: causes, symptoms, treatment
Postpartum mastitis ( mastitis nonpuerperalis ) is not related to breastfeeding and is much less common than postpartum mastitis. The incidence of this type of mastitis is closely correlated with age - specialists have observed two peaks in the incidence - the first affects women up to 30 years of age, the second - between the ages of 50 and 60.
In younger women, we usually deal with perineural mastitis, the most important risk factor of which is smoking. In addition, among the main causes of postpartum mastitis are:
- hyperprolactinemia
- thyroid dysfunction
- hypertension medications
- silicone breast implants
- nipple piercing
- urazy
- infection of the sebaceous and sweat glands
- bacterial diseases such as tuberculosis, syphilis, actinomycosis
Under the influence of hormonal disruptions, the mammary glands produce a secretion that, if not found, is easily contaminated by bacteria. Silicone implants and piercings cause chronic inflammation, and their insertion requires breaking the continuity of the coatings, which opens the way for microorganisms. Mastopathic changes (mastopathy), or rather their complications, are also a common cause of postpartum inflammation of the breast.
Symptoms of postpartum nipple include breast pain not related to the menstrual cycle, retraction of the nipple, discharge from the nipple. If an abscess has already begun to form - a movable tumor under the skin is palpable, and after its rupture - a purulent fistula.As in the case of puerperal mastitis, antibiotic therapy (cultures are taken and an antibiogram is performed), painkillers and compresses are administered. Unfortunately, non-puerperal mastitis is more likely to result in recurrences, as well as the formation of an abscess and fistula. sometimes the only solution is to excise the post-abscess bed.treatment should be histopathologically examined to exclude neoplastic background.
Neonatal breast inflammation: causes, symptoms, treatment
Many newborns have enlarged mammary glands within a few days after birth - a normal symptom caused by maternal hormones and disappears 2-3 weeks after birth. Unfortunately, sometimes the enlarged glands become superinfected, which results in neonatal mastitis ( mastitis neonatorum ). It occurs rarely, usually in full-term or near-term newborns, and is twice as likely in female as in male newborns. About 50 percent of babies with neonatal mastitis develop a breast abscess.