Mastitis
Clinically Relevant Anatomy[edit | edit source]
Mastitis is classified as the inflammation of the breast tissue and is often categorised as non-lactational mastitis and lactational mastitis.
Non-lactational mastitis includes idiopathic granulomatous mastitis (IGM) and periductal mastitis. IGM is a benign inflammatory condition, primarily affecting women within 5 years of giving birth. This is a rare type of mastitis, often mimicking breast cancer. Alternatively, periductal mastitis affects the sub-areolar ducts, primarily in women of reproductive age.
Lactational mastitis, also known as, puerperal mastitis is the most common form of mastitis. This typically occurs due to prolonged engorgement of the milk ducts which can progress to an bacterial infection, creating an abscess. While this form of mastitis can occur at anytime during lactation, it is more common in the first 6 weeks of breastfeeding and usually decreases after 3 months.
Epidemiology[edit | edit source]
Lactational mastitis is estimated to occur up to 20% of breastfeeding women. Meta-analysis from three studies reported 11.1 episodes per 1000 breastfeeding weeks from birth to 25 weeks post-partum. The risk of recurrences of mastitis is higher than in patients with no prior history.
Pathophysiology[edit | edit source]
Lactational mastitis occurs as a result of poor drainage of milk supply which can progress to infection if left untreated. Inadequate drainage is often a result of but not limited to; over-supply of milk, infrequent feeding, illness of mother or child, rapid weaning and clogged ducts. Bacteria from the mothers skin or infants mouth enter the stagnated milk via cracked nipples and grows leading to an infection. Causative organisms that colonise the mothers skin that result in a breast infection are Staphylococcus aureus, methicillin-resistant S aureus (MRSA), escherichia coli, streptococcus pyogenes, coagulase-negative staphylococci and bacteroides species.
While the etiology of periductal mastitis remains unclear, smoking is thought to be associated with the development of the condition due to the direct damage of the ducts, resulting in inflammation. Diabetes and obesity are also considered as risk factors.
The cause of IGM is also unclear, however, trauma, lactation, autoimmune diseases , hyperprolactinemia and use of oral contraceptive pill have been highlighted as a possible cause.
Clinical symptoms[edit | edit source]
- Mastalgia or tender nipples
- widespread swelling of the affected breast or both breasts
- Flu like symptoms: body aches, sore throat, fever (oral temperature more than 38° C or 100.4 F)
- Back pain/headaches
- Red streaks on breasts
- Painful, hot lump on breast
Risk Factors[edit | edit source]
- Hyperlactation
- Cracked/sore nipples
- Infant attachment
- missed feeds/changed routine
- rapid weaning
- illness of mother or baby
- maternal malnutrition
- maternal stress or excessive fatigue
- wearing tightfitting bra restricting milk flow
- chronic medical conditions- diabetes, AIDs, chronic illness, impaired immune system
Diagnostic Procedures[edit | edit source]
add text here relating to diagnostic tests for the condition
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions
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add text here relating to management approaches to the condition
Differential Diagnosis
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Engorgement
Engorgement occurs due to interstitial oedema with onset of lactation or accumulation of excess breastmilk.
Engorgement vs mastitis
Engorged breasts usually feel hard/tight while mastitis is often characterised by swelling/redness. while both can cause pain, pain from mastitis can worsen when the baby feeds and is described as "burning pain". Furthermore, breast engorgement won't generally cause flu like symptoms which mastitis can.
Clogged duct vs mastitis
A clogged duct is usually characterised by a "wedge-shaped" hard hot lump that appears on the breast while mastitis usually affects a larger widespread area of the breast. The pain and tenderness caused by a clogged duct is usually confined to the immediate area around the lump while in mastitis, the pain encapsulates the whole breast. Furthermore,
| Mastitis | Engorgement | Clogged ducts | |
|---|---|---|---|
| Lump/swelling | Widespread swelling of the breast | Widespread swelling of the breast | Localised, well defined lump |
| Pain/tenderness location | Pain/tenderness encapsulates the whole breast | ||
| Type of pain | Burning pain | ||
| Pain relieving factors | |||
| Flu like symptoms | body aches, fever |
Resources
[edit | edit source]
Introduction referenceshttps://www.ncbi.nlm.nih.gov/books/NBK557782/#:~:text=Mastitis%20is%20inflammation%20of%20the,idiopathic%20granulomatous%20mastitis%20(IGM).
Epidemiology
https://medilib.ir/uptodate/show/798
