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Mastitis

Mastitis is an inflammation of the breast that may be accompanied by infection. Mastitis mostly occurs during the first six weeks post-partum, however, it can also occur at any other point during lactation. Causes of mastitis are linked to insufficient milk drainage, milk stasis and inflammation. Blocked ducts and engorged breasts can also lead to mastitis if they are not treated appropriately.

Mums can be predisposed to mastitis for a number of reasons, which may include damaged nipples, especially if colonised with Staphylococcus aureus and illness or stress. Other factors that can lead to mastitis include long periods between breastfeeds or infrequent feeding, poor attachment to the breast leading to insufficient milk removal, tight clothing around the breast, over-supply of milk, rapid weaning and a white spot on the nipple.

Signs of mastitis

Mastitis may be defined as a tender, warm or hot, swollen, wedge-shaped area of the breast, usually accompanied by a fever (>38.5C). Mastitis symptoms can sometimes be mistaken for flu. Mastitis may also refer to inflammation of the breast appearing as breast redness, breast pain and heat when the breast is engorged (link to engorgement topic) or blocked, without the presence of infection. Engorgement can still lead to infective mastitis and breast abscess if not treated appropriately. Mastitis can get worse within just a few hours and needs immediate treatment.

Evaluation

Consultation with a medical professional immediately after symptoms develop is recommended for diagnosis and mastitis treatment. In most cases, laboratory investigations or other diagnostic procedures are not normally recommended, unless:

  • mastitis has previously been diagnosed and there is no response to treatment
  • the mastitis reoccurs
  • it is hospital-acquired mastitis
  • allergies to usual antibiotics exist
  • or the case is severe or unusual

Management

A management plan should be implemented with a healthcare professional or lactation consultant.

In conjunction with advice from a healthcare professional, evidence-based strategies that may be implemented include:

  • Feeding with the affected side first and breastfeeding frequently to help clear blockages. If pain interferes with milk ejection (let down), mums can start with the unaffected breast instead
  • Help with positioning and attachment, trying different feeding positions to try and clear a blockage if present
  • Resting as much as possible
  • Warming the breast with heat packs before feeding to help stimulate milk flow and cooling with cool packs after a feed to help relieve pain and inflammation
  • Using analgesics: following consultation with a medical professional, analgesics may be recommended to help with pain and milk ejection. In particular, an anti-inflammatory agent such as Ibuprofen is considered safe during breastfeeding
  • Consultation with a medical professional regarding the need for pharmacological treatment vs. non-pharmacological treatment
  • Using antibiotics: if the mum is ill or symptoms have not improved within 12 hours, antibiotics are usually recommended for the treatment of mastitis
  • Completing the whole course of antibiotics is recommended. An antibiotic that is effective and compatible with breastfeeding should be chosen. During this time the mum should continue breastfeeding, as there is no evidence of risk to a healthy term baby feeding from a mum with mastitis, and continued milk removal is important
  • Different antibiotics are required if mastitis is caused by methicillin-resistant  aureus(MRSA). If MRSA is present in the community, breast milk culturing and assay of antibiotic sensitivities may be required if the mastitis does not improve
  • If symptoms of mastitis do not clear within a few days, a wider differential diagnosis should be considered to confirm resistant bacteria, abscess formation or another breast issue.
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