Mastitis

Definition

Mastitis is an infection of the breast tissue that results in breast pain, swelling, warmth and redness of the breast. If you have mastitis, you might also experience fever and chills. Mastitis most commonly affects women who are breast-feeding (lactation mastitis), although in rare circumstances this condition can occur outside of lactation.

In most cases, lactation mastitis occurs within the first three months after giving birth (postpartum), but it can happen later during breast-feeding. The condition can leave you feeling exhausted and rundown, making it difficult to care for your baby.

Sometimes mastitis leads a mother mistakenly to wean her baby before she intends to. But you can continue breast-feeding while you have mastitis.

Mastitis

Mastitis

Mastitis, which mainly affects breast-feeding women, causes redness, swelling and pain in one breast....

Symptoms

With mastitis, signs and symptoms can appear suddenly and may include:

• Breast tenderness or warmth to the touch
• General malaise or feeling ill
• Swelling of the breast
• Pain or a burning sensation continuously or while breast-feeding
• Skin redness, often in a wedge-shaped pattern
• Fever of 101 F (38.3 C) or greater

Although mastitis usually occurs in the first several weeks of breast-feeding, it can happen anytime during breast-feeding. Lactation mastitis tends to affect only one breast — not both breasts.

When to see a doctor
In most cases, you'll feel ill with flu-like symptoms for several hours before you recognize that there's a sore red area on one of your breasts. As soon as you recognize this combination of signs and symptoms, it's time to contact your doctor.

Your doctor will probably want to see you to confirm the diagnosis. Oral antibiotics are usually very effective in treating this condition. If you've had mastitis before, your doctor may prescribe antibiotics over the phone. If your signs and symptoms don't improve after the first two days of taking antibiotics, see your doctor right away to make sure your condition isn't the result of a more serious problem.

Causes

Mastitis occurs when bacteria enter your breast through a break or crack in the skin of your nipple or through the opening to the milk ducts in your nipple. Bacteria from your skin's surface and baby's mouth enter the milk duct and can multiply — leading to pain, redness and swelling of the breast as infection progresses.

Risk factors

Things that put you at increased risk of mastitis include:

• Sore or cracked nipples, although mastitis can develop without broken skin
• A previous bout of mastitis while breast-feeding — if you've experienced mastitis in the past, you're more likely to experience it again
• Using only one position to breast-feed, which may not fully drain your breast
• Wearing a tightfitting bra, which may restrict milk flow

Complications

Complications that may arise from mastitis include:

• Recurrence. Once you've had mastitis, you're more likely to get it again, either breast-feeding the same infant or a future child. Delayed or inadequate treatment is usually to blame for mastitis recurrence.
• Milk stasis. When the milk isn't completely drained from your breast during breast-feeding, milk stasis can occur. This causes increased pressure on the ducts and leakage of milk into surrounding breast tissue, which can lead to pain and inflammation.
• Abscess. When mastitis is inadequately treated, or if it's related to milk stasis, a collection of pus (abscess) can develop in your breast. An abscess usually requires surgical drainage. To avoid this complication, talk to your doctor as soon as you develop signs or symptoms of mastitis.

Preparing for your appointment

For mastitis, your first appointment will likely be with your regular health care provider, such as an obstetrician-gynecologist, family doctor or nurse practitioner. For problems related to breast-feeding, you may be referred to a lactation consultant.

What you can do
To prepare for your appointment:

• Take note of all your symptoms, even if they seem unrelated to the reason for which you scheduled the appointment.
• Review key personal information, including major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements that you regularly take.
• Write down questions to ask your doctor. List your questions from most important to least important in case time runs out.

For mastitis, some basic questions to ask include:

• Will my infection clear on its own, or will I need treatment?
• What can I do at home to relieve my symptoms?
• How might my condition affect my baby?
• Is there any reason why I should stop breast-feeding my baby?
• I'm still breast-feeding. Is the medication you're prescribing safe to take while breast-feeding?
• How long will I have to take the medication?
• What are the chances that the infection will recur? What can I do to minimize my risk of recurrence?

What to expect from your doctor
Your doctor may ask you questions about:

• How long you've experienced symptoms
• Whether you experience any breast pain and the severity of your pain
• Whether symptoms occur in one or both breasts
• Your breast-feeding technique
• Whether you've had previous breast infections

Tests and diagnosis

Your doctor diagnoses mastitis based on a physical examination, taking into account signs and symptoms of fever, chills and a painful area in the breast. Another clear sign is a wedge-shaped area on the breast that points toward the nipple and is tender to the touch. As part of the examination, your doctor will make sure you don't have a breast abscess — a complication that can occur when mastitis isn't treated promptly.

Treatments and drugs

Mastitis treatment usually involves:

• Antibiotics. Treating mastitis usually requires a 10- to 14-day course of antibiotics. You may feel well again 24 to 48 hours after starting antibiotics, but it's important to take the entire course of medication to minimize your chance of recurrence.
• Self-care remedies. Resting, continuing breast-feeding and drinking extra fluids can help your body overcome the breast infection. Empty the milk from your affected breast frequently. If your baby refuses to nurse on the affected breast, use a breast pump or hand express the milk to empty your breast.
• Adjustments to your breast-feeding technique. Making sure that you fully empty your breasts during breast-feeding and that your infant latches on correctly are key to avoiding bouts of mastitis. Your doctor may review your breast-feeding technique with you or may refer you to a lactation consultant for help and ongoing support.

If your mastitis doesn't clear up after taking antibiotics, check back with your doctor. A rare form of breast cancer — inflammatory breast cancer — can also cause redness and swelling that could initially be confused with mastitis. Your doctor may recommend a diagnostic mammogram, and you may need a biopsy to make sure you don't have breast cancer.

Lifestyle and home remedies

If you have mastitis, it's safe to continue breast-feeding. Continuing breast-feeding offers the added benefit of helping clear the infection in your breast.

To relieve your discomfort:

• Maintain your breast-feeding routine.
• Get as much rest as possible.
• Avoid prolonged engorgement before breast-feeding.
• Use varied positions to breast-feed.
• Drink plenty of fluids.
• If you have trouble emptying a portion of your breast, apply warm compresses to the breast or take a warm shower before breast-feeding or pumping milk.
• Wear a supportive bra.
• While waiting for the antibiotics to take effect, take a mild pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).

If breast-feeding on the infected breast is too painful or your infant refuses to nurse on that breast, try pumping or hand-expressing milk.

Prevention

To get your breast-feeding relationship with your infant off to its best possible start — and to avoid complications such as mastitis — consider making an appointment with a lactation consultant. A lactation consultant can give you tips and provide invaluable advice for proper breast-feeding technique.

Minimize your chances of getting mastitis by fully draining the milk from your breasts while breast-feeding. Allow your baby to completely empty one breast before switching to the other breast during feeding. If your baby nurses for only a few minutes on the second breast — or not at all — start breast-feeding on that breast the next time you feed your baby.

Alternate the breast you offer first at each breast-feeding, and change the position you use to breast-feed from one feeding to the next. Make sure your baby latches on properly during feedings. Finally, don't let your baby use your breast as a pacifier. Babies enjoy sucking and often find comfort in suckling at the breast even when they're not hungry.