Section: Breast Curriculum: Curriculum, page 10
Definition
- Lactational mastitis is inflammation of the breast tissues associated with breastfeeding.
- Ductal narrowing leads to poor drainage and subsequent inflammation, edema, and compression of additional milk ducts.
- Breast milk can contain bacteria; incomplete breast emptying may result in organisms growing and proliferating into infectious mastitis.
Incidence
- Highest in the 2nd & 3rd weeks post-partum
- 4-30% of post-natal women
- More common in primipara
Classification
- Non-infective: inflammatory reaction following leakage of milk into surrounding tissue
- Infective: cellulitis of interlobular connective tissue or within duct system
Aetiology / Path
- Nipple trauma
- Often caused by poor baby positioning (e.g. nipple feeding instead of breastfeeding) → cracks or fissures
- Bacteria enter via cracks / fissures
- S. aureus = most common Strep = less common
- Stasis
- Oversupply / stasis / engorgement
- Obstruction – e.g. tight bra
- Ductal narrowing
Clinical
- Often a lump can be found localised to one of the lobes, indicating a blocked duct
- Overlying skin: erythema, oedema, tenderness +/- systemic unwellness
Investigations
- Simple bloods
- USS if concerned re abscess
Management
Mechanical
- Empty the breast
- Regular feeding; Educate mother (± with a lactation consultant)
- Expression
- Moist heat (shower, soaks, facecloths) for 10-15mins before feeds
- Gentle massage of any lumpy areas towards the nipple
Antibiotics
- Flucloxacillin/Augmentin or a cephalosporin for 10/7 (or erythromycin if allergic)
- Avoid tetracycline, cipro or chloramphenicol as can harm baby
- If abscess develops may require aspiration (or I+D) - Incision as far away from the nipple as possible
Prognosis / Natural Hx:
- Usually resolves with above Mx
- Prolonged inflammation can → Necrosis of breast tissue and fibrosis