Lactational mastitis is …
inflammatory condition of interlobular connective tissue
incidence of lactational mastitis
10% breastfeeding women
complication of lactational mastitis is
breast abscess
causes of mastitis
milk stasis caused either by i) overproduction of milk or ii) insufficient removal of milk
leading cause of mastitis in breastfeeding women
milk stasis: accumulation of milk causes an inflammatory response
(2) causes of mastitis in non breastfeeding women
- central/subareolar infection - peripheral infection
risk factors for infection causing mastitis
- Diabetes - RA - trauma - corticosteroids - immunosuppression
symptoms of mastitis
- painful, tender, erythematous - tiredness/feeling unwell
most common causative organism in infectious mastitis
Staphylococcus aureus
most common causative organisms in infectious mastitis in non breast feeding women
- staph aureus - enterococci
risk factors in lactating women
a) Poor infant attachment to nipple b) Reduced no. + duration of feeds c) Pressure on breast d) Age
causes of poor infant attachment to nipple
- infant mouth abnormalities: cleft lip/palate - short frenulum in infant
age RF for lactational mastitis
21-35 years
non lactational risk factors
- smoking - nipple damage - breast trauma - immunosuppression (HIV, DM, therapy) - nulliparity
4 causes of nipple damage
- piercing - eczema - infection - raynauds disease
underlying breast abnormalities that can cause mastitis
cyst + tumour –> persistent poor drainage of part of breast leading to infection
complications of mastitis
- inability to breastfeed in future - scarring e.g. from needle aspiration - sepsis: espec in immunocompromised patients
management of mastitis
- continue breastfeeding
management of mastitis if breastfeeding is too painful
express milk by hand from both breasts
3% of women with mastitis develop –>
Breast abscess
breast abscess are:
localised collection of pus within the breast.
location of lactational abscesses
peripheral breast, commonly upper + outer quadrant
location of non lactational breasts
lower quadrants of breast
symptoms/signs of breast abscess (skin + palpation + systemically)
skin = erythematous, visibly swollen, small fissure on nipple palpation: tender mass, warm systemic: fever
