What is Mastitis? Symptoms and Treatment

Mastitis occurs as a result of inflammation of the breast tissue, usually in breastfeeding women. It can occur in different ways, from a small, localized rash to a breast abscess. In cases where mastitis affects both breasts, the feeding relationship between mother and baby may be disrupted. However, it is very important for women who have mastitis problems to continue breastfeeding their babies.

What is Mastitis?

What does mastitis mean? Mastitis is an inflammatory disease of the breast tissue, with or without infection, that may occur with redness, swelling, tenderness and pain in the breast. The disease can progress from a non-infective inflammation to an infectious disease and finally to abscess formation.

It is a common health problem in breastfeeding women. This condition is called lactational mastitis (puerperal).

Mastitis can also occur less frequently in non-breastfeeding women and men. Mastitis seen in women who do not breastfeed is called nonlactational mastitis.

Periductal mastitis, one of the mastitis that occurs in the breast outside of breastfeeding, starts around the nipple and is 90% related to smoking. It is seen in young patients with an average age of 35. It is thought that smoking causes damage to the milk ducts behind the nipple and increases the tendency towards bacteria.

Another type of mastitis is autoimmune (more than normal reaction of immune system elements against breast tissue) mastitis, called Idiopathic granulamotous mastitis, whose cause is unknown and is seen in patients of young childbearing age.

In addition, although rare, mastitis due to diseases such as tuberculosis mastitis, fungal mastitis and sarcoidosis can be seen in the breast. Tuberculous mastitis and other mastitis are more common in developing countries such as our country and in patients with suppressed immune systems (such as AIDS, chronic renal failure).

Here we will talk about mastitis, which we call lactational mastitis, seen in postpartum breastfeeding mothers.

Mastitis is seen in 3-20% of breastfeeding mothers. It most often occurs in the first 6 weeks after birth. Although it can be seen at any time during lactation, its incidence begins to decrease after 3 months.

What Causes Mastitis?

Basic mechanisms in the development of mastitis; Insufficient discharge of milk from the breast, milk pooling in the breast and bacterial growth in the milk.

• Blockage in the Milk Duct: 

The most common cause of lactational mastitis is milk accumulation in the breast. Giving milk is something learned through experience. Inadequate breastfeeding technique and weak suction power of the newborn baby cause the milk in the breast to not be adequately drained. In addition, although rare, this milk stasis, which can occur due to reasons such as external pressure that prevents the flow of the ducts that drain the milk, creates a breeding ground for bacteria and paves the way for mastitis.

• Bacterial Infection in the Breast:

Normally, there are many bacteria on the skin. Therefore, while mastitis can be caused by these bacteria on the skin on the breast, bacteria can also spread into the breast tissue through a crack, scratch-like opening on the nipple. Wounds and cracks on the nipple; While it affects breastfeeding by causing pain, it also creates a gateway for bacteria in the baby’s mouth and skin flora.

In addition, breast pads made of inappropriate materials (plastic derivatives) used by the mother can cause irritation in the nipple and form the basis for mastitis.

With the onset of mastitis, some cytokines belonging to the body’s defense system against infection go to the infection site and initiate the infection response. This manifests itself as pain, swelling, redness and increased temperature.

There are other factors that may pose a risk for mastitis.

These factors:

• Having had mastitis before
• Cracks and injuries in the nipple
• Not applying correct breastfeeding techniques
• Extreme fatigue and stress
• Not enought feeding
• To smoke
• Behaviors that may restrict the flow of milk in the breast, such as rarely wearing a tight bra for a long time, wearing tight clothes, wearing a seat belt directly over the breast, and carrying heavy objects on the lap, can be listed as behaviors that may restrict the flow of milk in the breast.

What are the symptoms of mastitis?

Mastitis symptoms may vary depending on the degree of the disease. However, mastitis symptoms generally tend to progress rapidly.

Common mastitis symptoms can be listed as follows:

• Redness, swelling and tissue hardness in the breast,
• Increased temperature in the breast,
• Feeling severe pain in the breast when the relevant breast tissue is touched,
• Burning sensation that occurs constantly or during breastfeeding,
• Swelling in the armpit lymph nodes,

When the infection progresses in mastitis, in addition to the above:

• Anxiety, feeling stressed
• Fire
• Shake
• Fatigue, weakness
• feeling down
• Symptoms such as general body pain may also be observed.

When mastitis is left untreated, some complications may develop. These complications are as follows:

• Recurrent Mastitis:Women who have had mastitis once have a higher risk of recurrence of this condition. Recurrence of mastitis is usually caused by inadequate treatment or late initiation of treatment.
• Abscess:In cases that are left untreated and become chronic mastitis, pus collection in the breast tissue and abscess formation may occur.
• Sepsis:Sepsis occurs when the infection in the breast spreads throughout the body. Although rare, sepsis can cause very serious health problems.

How is Mastitis Diagnosed?

The patient’s history and examination are usually sufficient for the diagnosis of mastitis. The doctor may ask the patient what her complaints are, the situations that increase or decrease her complaints, and her breastfeeding routine. During the examination; The breasts are evaluated in terms of features such as color change, temperature increase and size. It is checked whether there are areas of the breast that are painful to touch. If the history and examination are compatible with inflammation in the breast, mastitis can be diagnosed. Imaging methods (ultrasonography) and interventional methods (abscess drainage with a needle, sampling) can be used for the diagnosis of mastitis and subsequent breast abscess.

A type of cancer called inflammatory breast cancer causes symptoms similar to mastitis in the breast. Although inflammatory breast cancer is rare, a doctor may use imaging techniques such as breast ultrasound or mammography to make sure of the diagnosis. If the patient’s mastitis symptoms do not go away despite treatment, a breast biopsy may be taken to rule out the risk of cancer.

Mastitis Treatment

In the treatment of mastitis, drug therapy is usually sufficient. Medicines used to treat mastitis are as follows:

• Antibiotics:In case of mastitis due to infection, 7-10 days of antibiotic use may be necessary. The prescribed antibiotic should be used until it is completely finished. Some patients stop using antibiotics as symptoms ease. However, it should not be forgotten that in this case, mastitis may recur and a persistent mastitis problem may occur. When mastitis recurs, stronger antibiotics may be needed to eliminate the infection.
• Painkillers: Medicines such as paracetamol help reduce the pain felt in the breast in mastitis.

The most important point to consider during the treatment of mastitis is that breastfeeding should not be stopped and even breastfeeding should be done more frequently. Continuing to breastfeed the baby regulates the flow of milk in the breast and prevents the symptoms of mastitis from aggravating. Also, it should not be forgotten that the ideal food for the baby, especially in the first 6 months, is breast milk.

Cessation of breastfeeding during mastitis may lead to increased milk accumulation in the breast and the development of abscesses. If abscess development is suspected in patients with mastitis, ultrasonography should be performed to check whether there is an abscess. If an abscess is found, it is necessary to drain the abscess using ultrasonography-guided drainage or surgery. It is necessary to examine the drained fluid microbiologically, that is, culture and antibogram.

It is wrong for mothers to think that by continuing to breastfeed during mastitis, ‘the baby will be infected with germs’. Moreover, breast milk contains high amounts of anti-inflammatory substances. This is even protective for the baby.

Sometimes mothers complain that the baby does not want to suck the sick breast during mastitis. This is due to the change in the taste of the milk. In this case, the breast must be emptied with a pump.

Can Mastitis Be Cured with Home Treatments? How to Pass?

What can be done for women with mastitis in their breasts is as follows:

• Breastfeeding the baby frequently
• It is recommended to start breastfeeding with the breast with mastitis first. Since the baby will be hungrier, he will suck the breast more strongly and thus it will be easier to empty the milk.
• If milk remains in the breast after breastfeeding, express the milk,
• It is also important to breastfeed the baby in different ways instead of breastfeeding in the same position all the time.
• Massage from above the breast to the nipple can have a positive effect on preventing the development of mastitis as it facilitates milk flow during breastfeeding.
• drinking plenty of fluids
• To rest
• Taking a warm shower and applying warm or hot compresses to the breast

What Should Be Done to Avoid Mastitis?

Breast pain and hardness are very common in breastfeeding mothers. It is very important to apply correct breastfeeding techniques to prevent this situation from continuing and turning into mastitis.

Recommended methods for breastfeeding:

• Excessive filling of the breast with milk should be avoided and the baby should be breastfed frequently.
• It should be ensured that the baby grasps the nipple and head correctly and completely, and if necessary, the nipple should be placed in the baby’s mouth with the help of a hand.
• If the milk coming from the breast is a little delayed, a few drops of milk should be released by massaging it with your hand before breastfeeding.
• The baby should be breastfed in different positions and all quadrants should be emptied.
• If milk remains in the breast after breastfeeding, excess milk should be expressed.
• The nipple should be checked daily to see if there are any wounds or scratches.
• Nipple moisture should be supported with protective creams,
• Warm and hot compresses should be applied to the breast and massaged before breastfeeding.
• When the baby is weaned, it should be weaned slowly, not suddenly.
• Tight bras and tight clothes should not be worn and pressure should not be put on the breasts.
• Daily showering and hygiene should be taken into consideration.
• The use of probiotics may be recommended. Studies are reported on the effect of probiotics on preventing the development of mastitis.

Mastitis during pregnancy and especially in breastfeeding women is a common health problem. It is very important to diagnose mastitis at an early stage and start treatment. In this way, the mother can return to breastfeeding her baby comfortably. In addition, complications due to delay in mastitis treatment are prevented. Therefore, women who have symptoms such as breast tenderness and redness should consult the nearest health institution without delay.