About Lactation Mastitis

Overview

Lactation mastitis is an inflammation of the breast that commonly occurs during breastfeeding. Symptoms of lactation mastitis include:

Breast redness and swelling
Breast tenderness
Fever
Chills
Flu-like symptoms

The condition can be extremely painful and distressing for breastfeeding women. Lactational mastitis is estimated to occur in up to 20% of breastfeeding women, with most cases reported in the first month after giving birth. It can be caused by factors such as:

Milk stasis
Physical damage to the nipple or breast
Poor nursing or hygiene practices
Infections by bacteria like Staphylococcus aureus and Staphylococcus epidermidis

In severe cases, abscesses may form and require surgical intervention or antibiotics. It is important to note that mastitis can occur at any time during breastfeeding and may lead to premature weaning if not properly managed.

Causes and Risk Factors

The causes of lactation mastitis can be divided into non-modifiable risk factors and modifiable risk factors.

Non-modifiable risk factors for lactation mastitis are factors that can’t be changed, including:

Previous mastitis during breastfeeding: If a woman has had mastitis in the past while breastfeeding, she may be at a higher risk of developing it again.

Modifiable risk factors for lactation mastitis are factors that can be influenced or changed, including:

Milk overproduction: When there is an excessive production of breast milk, it can lead to engorgement and difficulty in completely emptying the breasts, which increases the likelihood of developing mastitis.
Blocked ducts: A blocked milk duct can prevent the proper flow and removal of milk from the breast, increasing the risk of mastitis.
Cracked nipples: Cracks or fissures in the nipples can provide an entry point for bacteria to enter the breast tissue and cause infection.
Breast trauma: Any injury or trauma to the breast can increase the risk of lactation mastitis. This can include accidental bumps or hits to the breast.
Use of nipple shields: Nipple shields are sometimes used to assist with breastfeeding, but they can interfere with proper milk removal and increase the risk of mastitis.
Use of breast pumps: Improper use or hygiene practices with breast pumps can introduce bacteria into the breast tissue, leading to infection and mastitis.
Latch problems 8 weeks post-delivery: Difficulties with latching onto the breast can lead to inadequate milk removal and increased risk of mastitis.

It's important to note that while these risk factors may increase the likelihood of developing lactation mastitis, not all women with these risk factors will develop the condition. Taking steps to address modifiable risk factors, such as seeking support for latch issues or practicing good hygiene with breastfeeding equipment, may help reduce the risk of developing lactation mastitis.

Symptoms

Lactation mastitis is a common breast disorder experienced by postpartum women. It is characterized by a red, swollen, hot, and tender area of the breast.

In addition to these early symptoms, there are other common symptoms that may occur with later stages, progression, or higher severity of lactation mastitis. These symptoms include:

Fever: A fever is a common symptom that can accompany lactation mastitis. It is usually accompanied by other flu-like symptoms such as headache and body aches.
Headache: Many women with lactation mastitis experience headaches as a symptom. This can be a result of the inflammation and infection in the breast tissue.
Swelling: As lactation mastitis progresses or becomes more severe, swelling of the breast tissue may occur. This can contribute to the redness and tenderness experienced in the affected area.
Lump or thickening of breast tissue: In some cases, lactation mastitis can cause a lump or thickening of the breast tissue. This can be concerning for individuals experiencing this symptom.
Redness: Redness is a common symptom of lactation mastitis, especially in the shape of a wedge. The affected area may appear redder than the surrounding skin.
Unusual nipple discharge: In more severe cases or as lactation mastitis progresses, some individuals may experience unusual nipple discharge. This discharge is likely to be white, green, or black in color.
Inverted nipples: Lactation mastitis can also cause the nipples to become inverted or turn inward. This can be uncomfortable and may affect breastfeeding.

It's important to note that lactation mastitis can occur at any time during breastfeeding, not just in the early stages. If you experience any of these symptoms, it's important to reach out to a healthcare professional for evaluation and appropriate management.

Diagnosis

To diagnose lactation mastitis, healthcare providers may perform the following examinations, tests, and procedures:

Clinical examination: A healthcare provider will conduct a physical examination of the breasts to look for signs of mastitis. This includes checking for breast lumps, redness, pain, increased skin temperature, and any systemic inflammatory reactions such as chills, headache, and fatigue.
Milk analysis: Milk samples may be collected for laboratory testing. These tests can include somatic cell counts (SCC), which measure the number of immune cells in the milk, as well as analysis of milk components such as lactose, protein, fat, and solids-not-fat (SNF). These tests help identify any abnormalities in the milk composition.
Bacterial culture: A sample of milk may be cultured in a laboratory to identify the specific bacteria causing the infection. This helps determine the appropriate treatment.
California mastitis test (CMT): This is a simple and commonly used test to assess the presence of mastitis. It involves adding a reactive substance to a milk sample and visually evaluating its viscosity (thickness). An increase in viscosity indicates the presence of inflammation.
Electrical conductivity: Another method to detect mastitis is by measuring the electrical conductivity of milk. Mastitis causes changes in electrical conductivity due to increased levels of electrolytes in the milk.

Additional examinations, tests, and procedures may be performed to determine the stage or severity of lactation mastitis:

Ultrasonography: An ultrasound examination may be done to assess the breast tissue and look for any fluid collections or abscesses. The presence of fluid flow after pressurization can indicate an infection.
Blood tests: Routine blood examinations can help identify systemic inflammatory reactions associated with mastitis. Increased white blood cell (WBC) count, neutrophils (NE), or C-reactive protein (CRP) levels in blood tests suggest an ongoing infection.
Pus discharge evaluation: If there is pus discharge from the breast, it can indicate a more severe stage of mastitis.

It's important for healthcare providers to consider all available information when diagnosing lactation mastitis, including medical history, physical examination findings, milk analysis results (such as SCC), bacterial culture results, ultrasonography findings, and blood test results. These diagnostic tools help healthcare providers make accurate decisions regarding treatment options for lactation mastitis.

Treatment Options

The goals of treatment for lactation mastitis include:

Treating the infection
Relieving symptoms
Preventing complications

There are several types of treatments and therapies that can help achieve these goals, including:

Antibiotic therapy: Antibiotics are commonly used to treat lactation mastitis caused by bacterial infections. These medications work by killing or inhibiting the growth of bacteria in the breast tissue. They are usually prescribed for a specific duration, and it's important to complete the full course of antibiotics even if symptoms improve.
Pain relief: Pain relievers such as acetaminophen or ibuprofen may be recommended to help alleviate the pain and discomfort associated with lactation mastitis. These medications can also help reduce inflammation in the breast tissue.
Frequent breastfeeding or pumping: One of the key therapeutic procedures for lactation mastitis is frequent breastfeeding or pumping. This helps to empty the breasts regularly, preventing milk from building up and reducing the risk of infection. It also helps to improve milk flow and relieve breast engorgement.
Warm compresses: Applying warm compresses to the affected breast can help improve blood circulation, reduce swelling, and provide relief from pain. You can use a warm towel or a heating pad wrapped in a cloth. It's important to avoid applying excessive heat that could cause burns.
Cold compresses: Cold compresses can be used after breastfeeding or pumping to help reduce inflammation and swelling in the breast tissue. You can use a cold pack or a bag of frozen vegetables wrapped in a cloth. Apply it for about 15 minutes at a time.
Rest and self-care: Getting plenty of rest and taking care of yourself is essential for recovery from lactation mastitis. Make sure to get enough sleep, eat a healthy diet, stay hydrated, and avoid unnecessary stress.
Supportive measures: Wearing a well-fitting supportive bra can help reduce discomfort and provide additional support to the breasts. Avoid tight-fitting bras that can restrict milk flow and contribute to engorgement.

Progression or Complications

Lactation mastitis typically occurs within the first six to eight weeks after giving birth but can happen at any time during breastfeeding. If not managed properly or if breast care is incorrect, lactation mastitis can develop into more severe cases such as a breast abscess or sepsis. These severe cases can lead to the stopping of normal breastfeeding.

Breastfeeding is highly recommended by the World Health Organization (WHO) and international guidelines. Infants are encouraged to be exclusively breastfed for the first six months of life and continue breastfeeding for up to two years or longer. Breastfeeding provides optimal nutrition for infant growth and has beneficial effects on both infants and mothers' health outcomes.

Complications that commonly occur with lactation mastitis include:

Mastitis: This is an infection that arises from a clogged milk duct. It typically develops in one breast at a time and is characterized by discomfort, hard swelling, red streaks on the skin of the breast, hot skin around the clogged duct, intense pain in the breast, fever, and pus or blood in the breast milk. Mastitis is most common in the first three weeks after childbirth but can occur at any time during breastfeeding. Moderate or severe mastitis usually requires antibiotic treatment, and untreated mastitis may develop into a breast abscess.
Yeast infection: Women who nurse can develop a yeast infection in one or both nipples. This usually occurs when the nipple cracks. Symptoms include itchiness of the nipple, pain and sensitivity, white discharge from the nipple, and shooting pains in the breast after feeding. The yeast infection can also pass to the baby.

Treatment for lactation mastitis typically involves antibiotics to manage the infection. However, there has been growing interest in alternative approaches to prevent lactation mastitis occurrence without relying solely on antibiotics.

One study showed promising results using a probiotic strain called Lactobacillus salivarius PS2 isolated from human milk. This probiotic was found to reduce the risk of mastitis in healthy pregnant and lactating women. More research is needed to understand how probiotics work to treat and prevent mastitis and confirm their impact on breastfeeding outcomes.

It's important to consult with a healthcare provider for proper diagnosis and treatment of lactation mastitis. They can provide personalized advice based on your specific situation and guide you through managing lactation mastitis effectively while preserving breastfeeding goals.