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. Causes
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
- 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
- Continue with frequent Breastfeeding (except if Breast Abscess present)
- Risk of Breast Abscess if Breast engorgement occurs
- Ensure proper technique (see prevention below)
- Safe for infant to continue to feed despite infection with following exceptions
- Mother HIV positive
- Breast Abscess
- Discard Breast Milk for the first 24 hours on antibiotics
- Resume Breast Feeding after the first 24 hours on antibiotics
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
Images: Related links to external sites (from Bing)
Related Studies
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, ニュウボウエンショウ |
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 |
Ontology: Abscess of breast (C0151463)
Concepts | Disease or Syndrome (T047) |
SnomedCT | 198121003, 28432003 |
English | BREAST ABSCESS, Breast abscess, Abscess breast, abscess breast, abscesses breast, breast abscess, Breast abscess (disorder), Abscess of breast, Abscess of breast (disorder), breast; abscess, abscess; breast, Abscess of breast, NOS |
Italian | Ascesso mammario, Ascesso della mammella |
Dutch | abces borst, abces; mamma, mamma; abces, borstabces |
French | Abcès au sein, ABCES DU SEIN, Abcès du sein |
German | Abszess der Brust, BRUSTDRUESENABSZESS, Brustdruesenabszess |
Portuguese | Abcesso mamário, ABCESSO DA MAMA, Abcesso da mama |
Spanish | Absceso de mama, ABSCESO MAMARIO, absceso de la mama (trastorno), absceso de la mama, absceso mamario, Absceso mamario |
Japanese | 乳房膿瘍, ニュウボウノウヨウ |
Czech | Absces prsu |
Hungarian | emlő abscessus, emlőtályog |
Ontology: Mastitis associated with lactation (C0269985)
Concepts | Disease or Syndrome (T047) |
ICD10 | O91.23 , O91.22 |
SnomedCT | 86216003, 700038005 |
Italian | Mastite postpartum, Mastite puerperale |
Dutch | postnatale mastitis, puerperale mastitis, Mastitis puerperalis, lactatie; mastitis, mammitis; puerperium, mastitis; lactatie, mastitis; puerperium, mastitis postpartum |
French | Mastite postnatale, Mastite puerpérale, Mastite du post-partum |
German | postnatale Mastitis, Mastitis puerperalis, Mastitis postpartum |
Portuguese | Mastite puerperal, Mastite pós-parto |
Spanish | Mastitis postnatal, Mastitis puerperal, mastitis puerperal, mastitis postparto, mastitis asociada con el parto, mastitis asociada con la lactancia (trastorno), mastitis asociada con la lactancia, mastitis asociada con el parto (trastorno), mastitis posparto, Mastitis postpartum |
Japanese | 産褥乳腺炎, サンジョクニュウセンエン |
English | puerperal mastitis, puerperal mastitis (diagnosis), Postnatal mastitis, Mastitis postpartum, Mastitis NOS associated with lactation, Puerperal mastitis NOS, Mastitis;puerperalis, Postpartum mastitis, Mastitis associated with lactation, Puerperal mastitis, Mastitis associated with breastfeeding, Mastitis, associated with childbirth, Mastitis, associated with childbirth (disorder), Mastitis associated with lactation (disorder), lactation; mastitis, mammitis; puerperal, mastitis; lactation, mastitis; puerperal, Mastitis, NOS, associated with childbirth, Postpartum mastitis, NOS, Puerperal mastitis, NOS, mastitis puerperalis |
Czech | Puerperální mastitida, Poporodní mastitida |
Hungarian | mastitis puerperalis, Postnatalis mastitis, postpartum mastitis |
Ontology: Breast abscess during lactation (C2909506)
Concepts | Disease or Syndrome (T047) |
ICD10 | O91.13 |
SnomedCT | 10745131000119107 |
English | breast abscess associated with lactation (diagnosis), breast abscess associated with lactation, Abscess of breast associated with lactation (disorder), Abscess of breast associated with lactation, Breast abscess during lactation |