Mastitis

Mastitis is inflammation of the breast in most cases caused by an infection. The majority of mastitis cases occur in breastfeeding mothers, although it’s not uncommon in women who are not breastfeeding. It most commonly affects women between the ages of 18 and 50.

Most cases of mastitis are acute, that is to say the condition usually only lasts for a short period of time, however there are rare cases of chronic mastitis where the inflammation can last for long periods of time.

Chronic mastitis should not be confused with benign mammary dysplasia, or fibrocystic disease, where the breasts contain painful or tender nodules or cysts which change with the menstrual cycle and feel lumpy to touch.

Symptoms

The symptoms of mastitis may be quite severe, and can include:

• Fever
• Tender breasts
• Cracked painful nipple
• Redness, swelling, and hardening in the affected breast
• Severe breast pain when pressed
• Enlarged and tender lymph nodes under the armpit
• Flu like aches and pains
• Headache

If breastfeeding, you may notice that the infected breast is engorged, this is because it is not draining properly. The breastfed baby may not want to feed from the affected breast, because the infection can taint the taste of the breast milk.

Causes

Breastfeeding

The infections are often caused by bacteria entering the breast through a crack or break in the skin, these bacteria are normally harmless and commonly found on our skin, and they only cause harmful infection when they manage to penetrate inside the body. Good hygiene for both mother and baby such as regular washing can prevent the bacteria from multiplying on the skin and reduce the chances of infection.

Mastitis can also happen if the breast is not emptying fully at each feed. The breasts then become swollen, lumpy and sore, but symptoms are not as severe as when infection is involved. If a milk duct in your breast becomes blocked and infected, the same symptoms can happen, but they will be localised around the part of the breast containing the blocked duct.

None breastfeeding

• Infection elsewhere in the body, which then spreads to the breasts.
• Serious diseases such as tuberculosis, syphilis or actinomycosis can cause chronic mastitis if the infection spreads to the breast.
• If nipples become cracked from clothing friction burns, for example through exercise such as running, then infection can occur from bacteria entering the breast.
• Dirty nipple piercings.

Treatment

Mild cases of mastitis can be self treated by taking some simple measures:

• Hot showers or hot compresses will help to relieve the pain.
• After each feed, make sure your breast is empty and express any remaining milk if necessary.
• Give the baby the affected breast first, to make ensure it is fully drained. This maybe painful but is one of the best treatments for the mastitis. If the baby will not feed from the infected breast then you should consider emptying the breast by expressing with a breast pump. It is worth noting that the infection will not pass to the baby threw the breast milk.
• Try varying the feeding position of the baby, and ask your midwife or health visitor for advice on breastfeeding techniques
• Take painkillers such as ibuprofen and paracetamol for any pain, but do not take aspirin if you are breastfeeding.
• Some people recommend putting chilled leaves of a Savoy cabbage inside your bra, to relieve the pain and swelling; however cabbage leaves contain an enzyme which can dry up breast milk so they should be avoided if you are breastfeeding and only used for engorgement.
• If the mastitis is caused by a blocked milk duct then you may be able to clear it by feeding the baby more frequently from the affected breast, and using gentle massage of the breast while you feed.

Severe mastitis caused by infection requires urgent treatment with antibiotics. If you are breastfeeding your doctor will prescribe antibiotics that are safe to take.

If mastitis is left untreated it can develop into an abscess. An abscess is pus-filled hollow space that is caused by an infection. It can be treated by being drained, and your doctor will refer you to hospital for this procedure.

Prevention

The chances of getting mastitis during breastfeeding can be reduced by making sure that each breast is emptied fully at each feed, by expressing milk if necessary also check that your baby is latching on properly to your breast.

Good hygiene will also help, wash regularly but avoid using perfumed soaps that may irritate skin, pat dry rather than rubbing after washing. Change breast pads regularly and make sure you have a well fitting maternity bra. Clean your baby's gums and, when they appear, teeth, with baby toothpaste, to avoid transfer of bacteria from mouth to breast.

Regularly cleaning and carefully drying your breasts will also help avoid none breastfeeding mastitis. If you take part in active sports, wear a supportive bra, to prevent friction burns. Keep nipple piercings clean and sterile, particular when they are new and the skin has not healed.