Mastitis is clinically defined as a localized inflammation of the breast accompanied by flu-like signs and symptoms. It is equally common in the left or right breast. Mastitis frequently occurs during lactation, and it can lead to the discontinuation of breastfeeding.
The incidence of mastitis can be as high as 33% in certain populations of lactating women. Mastitis can occur at any time during lactation, but it is most common within the first month following delivery, and 75-95% of cases occur before the infant is three months old. (Department of Child and Adolescent Health and Development. "Mastitis: causes and management." Geneva, Switzerland: World Health Organization; 2000)
Many cases of mastitis are believed to arise from incomplete milk removal from the breast. Ongoing consultation with lactation specialists might reduce the risk for mastitis, but single counseling sessions do not seem to decrease the incidence. (de Oliveira LD, et al. "Effect of intervention to improve breastfeeding technique on the frequency of exclusive breastfeeding and lactation-related problems." J Hum Lact. 2006;22(3):315-321)
Risk Factors for Mastitis
- Infant with cleft lip or palate, or with short frenulum (“tongue-tied”)
- Difficulties with infant attaching to nipple
- Cracked or sore nipples
- Nipple piercing
- Missed feeding
- Localized stasis of milk (e.g., blocked milk ducts) or incomplete emptying of breast
- Plastic-backed breast pads or restriction from tight bra
- History of previous mastitis
- Poor maternal nutrition
- Coexisting yeast infection (thrush or diaper dermatitis)
- Use of manual breast pump
(Adopted from Spencer J. Management of mastitis in breastfeeding women. Am Fam Physician 2008;78(6):727-31)
Diagnosis of Mastitis
Patients present with localized, unilateral breast tenderness and redness. They also exhibit fever, malaise, body aches, fatigue and headache.
Routine culture is unhelpful, since positive results might indicate normal bacterial colonization, and negative results do not rule out infection. Culture is only necessary when infection is severe or if it is unresponsive to 48-72 hours of treatment with appropriate antibiotics.
Inflammatory breast cancer resembles mastitis. Any case of mastitis that does not respond to treatment should prompt further investigation.
Treatment of Mastitis
- It is important to continue to empty a breast where mastitis has developed. Stasis of milk increases the chances for abscess formation.
- Since mother and infant are already sharing the same organisms, there is no risk of transmitting bacterial infection to the infant. Indeed, breastfeeding supplies the infant with protective antibodies and affords the most efficient means for draining the breast.
- It has been shown that HIV is more efficiently transmitted from mother to infant when mastitis is present. For HIV-infected mothers who have no alternative means of feeding their infant, they should avoid feeding from the affected breast until the mastitis has cleared.
- Antibiotic therapy, usually directed against Staphylococcus aureus (the most common causative organism) is prescribed for 10-14 days.
- If there is a coexisting yeast infection, both mother and infant should be treated.
Complications of Mastitis
Abscess formation sometimes accompanies mastitis. Abscesses can be diagnosed with ultrasound examination, and they should be surgically drained or aspirated with a needle.
Probably the most common problem arising from mastitis is cessation of breastfeeding. Breastfeeding provides optimal nutrition for the infant and should be continued if at all possible.
Prevention of Mastitis
In addition to practicing optimal breastfeeding techniques (complete emptying, proper “latch” by infant, nipple maintenance, etc.) maternal hand washing prior to breastfeeding has been shown to reduce risk. For women with cracked nipples, antibiotic treatment—topical or oral—may prevent progression to mastitis.
Mastitis is a manageable condition that can interfere with breastfeeding. With counseling and proper treatment, most mothers can continue to breastfeed their infants.
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