Mastitis

Question 1

What is mastitis?

Answer 1

Localized infection of one/more mammary

ducts, usually associated with lactation (but there mght be other causes)

Question 2

Explain the pathophysiology of mastitis

Answer 2

1. Milk stasis due to
   
   1. Overproduction of milk
   2. Infrequent lactation
2. Makes it more likely to get infection of breast tissue
   
   1. Bacteria, most common Staph A
   2. Other risk factor: Fissure (eg. due to false lactation technique)

–> infection

Question 3

What are risk factors of developing mastitis?

Answer 3

• Female sex
• Women aged >30 years
• Lactation, particularly after 6 to 8 weeks of breastfeeding or at weaning
• Poor breastfeeding technique (may also be due to infant factors such as tongue-tie)
• Milk stasis (may be secondary to poor breastfeeding technique or tight-fitting bra)
• Nipple injury
• Previous mastitis
• Shaving or plucking areolar hair
• Anatomical breast defect, mammoplasty, or scar
• Other underlying breast condition, particularly breast cancer
• Nipple piercing
• Foreign body (e.g., silicone implant)
• Skin infection
• Positive carrier status for Staphylococcus aureus
• Immunosuppression (including diabetes mellitus).
  *

Question 4

What is the epidemiology of Mastitis?

Answer 4

In lactating women about 1-10% (may be higher)

• 3-11% of women with mastits develop a breast abscess

Question 5

What are possible symptoms of Mastits?

Answer 5

1. Tender, firm, swollen, erythematous breast (generally unilateral)
2. Pain during breastfeedin
3. Reduced milk secretion
4. Flu-like symptoms, malaise, fever, and chills

Question 6

What are the signs of mastitis on examination?

Answer 6

• Inflammed breast
  
  • Swolen, hot, red, tender
• Fever
• distant skin infections/ skin lesions
• axillar lymphadenopathy

Question 7

When would you suspect a breast abscess?

Answer 7

1. A tender palpable breast mass may indicate localised mastitis or breast abscess.
2. A fluctuant mass may be palpated in the case of a late breast abscess.

Question 8

Which investigations should be performed with mastitis?

Answer 8

• If no explanation
  
  • Make pregnancy test
• USS to look for abscess
  
  • consider fine needle drainage of abscess
• Cluture abscess aspirate/ disscharge from nipple
• FBC + diff if systemic infection, abscess, treatment failure
• TB test
• Examine newborn in lactation mastits is susprected

Question 9

How do you generally manage different types of Mastitis?

Answer 9

• Neonatal : referr to paediatrition
• with abscess: refere to surgeon
• Other types : try to prevent complications

Question 10

How would you manage lactational mastitis?

Answer 10

• Effective milk removal
  
  • Frequent nursing or breast pump
  • Encourage large fluid intake
• Consider Antibiotic therapy
• Warm compresses
• Symptomatic relief
  
  • Analgesia (e.g. ibuprofen, paracetamol)
• Supportive counselling (say breastfeeding is good and should be continued)

Question 11

What are possible complications of mastits?

Answer 11

1. Cecassion of Breasfeeding
2. abscess
3. systemic infection and sepsis
4. scarring
5. functional mastectomy
6. breast hypoplasia
7. other

Question 12

What is the prognosis of a patient with mastitis?

Answer 12

If managed properly, good

• Mastitis with ABX should be managed after 2-3 days
• Normally continuation of breasfeeding possible
• Non-lactational abscesses can be multifactorial and have a greater risk of becoming chronic
• May recurr