II. Epidemiology
- Incidence: 9-33% of lactating women
- Most common in first few weeks and nearly all cases within first 3 months
III. Pathophysiology
IV. Etiology
VI. Signs
VII. Labs: Milk Culture
- Indications (not routine)
- Severe Mastitis
- Refractory despite optimal antibiotics for at least 48 hours
- Hospital acquired infection
- Technique
- Cleanse nipple
- Hand express small quantity of Breast Milk and discard
- Hand express a sample into a sterile container
VIII. Differential Diagnosis
- Inflammatory Breast Cancer
IX. Management: General Measures
- Continue with frequent Breastfeeding
- Risk of Breast abscess if Breast engorgement occurs
- Safe for infant to continue to feed despite infection (except if mother HIV positive)
- Ensure proper technique (see prevention below)
- Tylenol or Ibuprofen
- Ensure adequate hydration
- Apply warm packs and local massage
- Alternate feeding positions
-
Antifungals (Monilial Infection)
- Topical Antifungals on Breast
- Oral Nystatin for infant
X. Management: Antibiotics
- Course: 10 to 14 days
- Coverage: Staphylococcus aureus (or as directed by culture)
- May observe localized Breast redness, tenderness without systemic symptoms or abscess for 24 hours
- For first 24 hours may use general measures above and hold antibiotics
- Start antibiotics by 24 hours if not improving, systemic symptoms, other risks
- Antibiotics: Nursing Mothers
- Amoxacillin-Clavulanate (Augmentin) 875 mg orally twice daily
- Cephalexin (Keflex) 500 mg orally four times daily
- Dicloxacillin 500 mg orally four times daily
- Clindamycin 300 mg orally four times daily (for MRSA)
- Antibiotics: Non-Breast Feeding women
XI. Management: Breast abscess
- Obtain Bacterial culture
- Needle aspiration under Ultrasound guidance (preferred, 60% effective)
- Attempt to irrigate the abscess via the same needle used for aspiration
- May repeat up to 3 times if fails to resolve (then incise in drain if still refractory)
-
Incision and Drainage
- Indicated in refractory cases (after 3 attempted needle aspirations)
- Also first-line measure in very superficial lesions, with skin thinning over the abscess
- References
- Sacchetti in Herbert (2016) EM:Rap 16(5): 1
XII. Follow-up
- Early antibiotics prevent abscess formation
- If not better in 48 hours examine Breast for abscess
- Consider Incision and Drainage
XIII. Prevention
- Optimal Breast Feeding Technique with good latch-on by infant
- Address predisposing factors early
- Sore nipples suggest problems
- Correct latch-on problems
- Address dry nipples with lanolin
- Avoid plastic-backed Breast pads
- Evaluate infant for anatomic problems (e.g. short frenulum, Cleft Palate)
- Cracked nipples colonized with Staphylococcus aureus should be treated
- Oral antibiotics (e.g. Dicloxacillin) are preferred
- Livingstone (1999) J Hum Lact 15:241-6 [PubMed]
- Blocked milk ducts should be unblocked
- Blocked ducts will appear with a bleb overlying a tender, red area adjacent to nipple
- Remove bleb with moist cloth
- Yeast infection should be treated (both infant and mother)
- Infant: See Thrush for management options
- Mother
- Topical agents: Nystatin or Ketoconazole
- Oral agents: Fluconazole 400 mg on day #1, then 200 mg orally daily for 10 days
- Chetwynd (2002) J Hum Lact 18:168-71 [PubMed]
- Sore nipples suggest problems
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| Definition (MSH) | INFLAMMATION of the BREAST, or MAMMARY GLAND. |
| Concepts | Pathologic Function (T046) |
| MSH | D008413 |
| SnomedCT | 155952005, 155955007, 266644004, 198099006, 266641007, 45198002 |
| French | MASTITE, Inflammation du sein, INFLAMMATION DU SEIN, Mammite, Mastite |
| English | BREAST INFLAMMATION, MASTITIS, Breast inflammation, Breast inflammation NOS, mastitis (diagnosis), mastitis, Mastitis [Disease/Finding], Mastitis, breasts inflammation, Breast inflammation NOS (disorder), Mammitis, Mastitis (disorder), breast; inflammation, inflammation; breast, Mastitis, NOS, Mastitis NOS |
| Portuguese | MASTITE, Inflamação da mama, INFLAMACAO DA MAMA, Mamite, Mastite |
| Spanish | MASTITIS, Inflamación mamaria, MAMA, INFLAMACION, inflamación mamaria, SAI, Breast inflammation NOS, inflamación mamaria, SAI (trastorno), Mamitis, mastitis (trastorno), mastitis, Mastitis |
| German | MASTITIS, Brustentzuendung, BRUSTENTZUENDUNG, Mammitis, Mastitis |
| Japanese | 乳腺炎, ﾆｭｳｾﾝｴﾝ, 乳房炎症, ﾆｭｳﾎﾞｳｴﾝｼｮｳ |
| Swedish | Bröstkörtelinflammation |
| Dutch | mastitis, borstontsteking, mammitis, mamma; ontsteking, ontsteking; mamma, Mastitis |
| Italian | Infiammazione mammaria, Mammite, Mastite |
| Czech | mastitida, Zánět prsu, Mastitida |
| Finnish | Mastiitti |
| Russian | MASTIT, МАСТИТ |
| Croatian | MASTITIS |
| Polish | Zapalenie sutka |
| Hungarian | Emlő gyulladás, mastitis, Mammitis |
| Norwegian | Brystkjertelbetennelse, Brystbetennelse, Mastitt |
