ACUTE MASTITIS

There are two types of mastitis.

(1) Infection follows a cracked nipple to involve the breast parenchymal tissue leading to
cellulities. The lacteal system remains unaffected.
(2) Infection reaches to lactiferous ducts leading to the development of primary
mammary adenitis.

Causes

The organism is predominantly staphylococcus aurous. In superficial cellulites, the onset if

acute during the first week of pilerperium. In mammary ademtis, the onset is insidious and
usually occurs near the end of the second week. The infection may occur even several weeks
after delivery.

Clinical Features

 Generalized malaise and headache

 Fever (1020 or over) with chills
 Severe pain and swelling in one quadrant of the breast with its apex at the nipple.
 The overlying skin is hot and flushed and feels tense and tender.

If not treated adequately, it can lead to destruction of breast tissue with the formation of a
breast abscess.

Treatment

 Prophylactic: Antenatal care to nipple prevention of engorgement and isolation of

infected baby.
 Curative: isolation of mother and baby suspension of breast feeding on the affected
side until the infection is controlled.
 Manual expression of milk to relieve engorgement
 Suppression of lactation by bromocryptine (parlodel) 2.5mg orally for 14 days.
 Antibiotics therapy for at least ten days.
 Analgesics and sedatives as required.
BREAST ABSCESS

Features–flushed breasts, brewing edema, marked tenderness and swinging temperature and a
cavity may formation. If an abscess is formed, it is to be drained under general anesthesia.
The cavity is packed with gauze which should be replaced after 24 hours, by a smaller pack.
The procedure is continued until it heals up.

NB

Simple needle and syringe aspiration may resolve it or incision and drainage. It is not
possible feed baby with affected breast for few days but expression of breast milk.

Causes

 Debilitating state if the mother

 Elderly primigravida
 Failure to suckle the baby regularly
 Depression or anxiety state in the pilarperium.
 Reluctance or apprehension to nursing
 Premature baby, who is too weak to suck.
 Ill development of breasts
 Painful breast lesion

Treatment

Antenatal

 Education regarding the advantages of breastfeeding

 Correction of abnormalities like retracted nipple
 Maintenance of adequate breast hygiene especially in the last two months of
pregnancy.
 Improving the general health status of mother postnatal.
 Encourage adequate fluid intake
 Nurse the baby regularly.
 Treat painful lesions promptly
 Express residual milk after each feeding
 Drugs like thyroid extract or prolactin are useful