MASTITIS

NCM 108
FRITZIE NECITAS A.DURAN, RN
LECTURER
 Mastitis
An acute inflammation of the
interlobular connective tissue within the
mammary gland
 Epidemiology
• Incidence 2-33%.
• Most common worldwide <10%
• Most common 2 nd
-3rd week postpartum
• 74-95% in first 12 weeks
• Can occur anytime in lactation

Presentation
• Systemic illness: Chills, myalgias
• Fever of ≥ 38.5 0C
• Tender, hot, swollen wedge-shaped erythematous area
of breast
• Usually one breast
Differential Diagnosis
• Fullness: bilateral, hot, heavy, hard, no redness
• Engorgement: bilateral, tender, +/- fever, minimal diffuse
erythema
• Blocked Duct: painful lump with overlying erythema, no fever,
feel well, particulate matter in milk

• Galactocele: smooth rounded swelling (cyst)

• Abscess: tender hard breast mass, +/-
fluctuance, skin erythema, induration, +/- fever
• Inflammatory Breast Carcinoma: unilateral,
diffuse and recurrent, erythema, induration
 Causes
• Milk Stasis
• Stagnant milk increases pressure in breast
leading to leakage in surrounding breast tissue
• Milk, itself, causes an inflammatory response
• +/- Infection
• Milk provides medium for bacterial growth
 Predisposing factors
• Improper nursing technique
• Timing of feeds
• Poor attachment
• Oversupply of milk
• Overabundant milk supply
• Lactating for multiples
• Rapid weaning
• Blocked nipple pore or duct
• Pressure on Breast
• Tight Bra
• Prone sleeping position
 Predisposing factors
• Damaged nipple (nipple fissure)
• Primiparity
• Previous history of mastitis
• Maternal or neonatal illness
• Maternal stress
• Work outside the home
• Trauma
• Genetic
 Flat or Inverted Nipples
• Begin treatment late in
pregnancy
• Stop if causes uterine
contractions
• Breast shells
• Wear 1 hour a day and
gradually increase to
several hours
• Dry area under nipple often
Offering Your Breast to
Baby

• Fingers underneath, thumb on top

of breast

• Fingers well behind areola

 Microbiology
• Detection of pathogens difficult
• Usually nasal/skin flora
• Difficult to avoid contamination
• Milk culture
• Encouraged in hospital acquired, recurrent
mastitis, or no response in 2 days
 Microbiology
• Staphylococcus Aureus
• Coagulase negative staphylococcus
• Also, Group A and B βhemolytic Strep, E. Coli, H. flu
• MRSA (methicillin-resistant staphylococcus aureus)
• Fungal infections
• TB where endemic – 1% of cases
 Fungal infections
• Cryptococcal infection may mimic a neoplastic lesion
• Most common: Candida Albicans
• Genital tract
• Newborn oral colonization
• May lead to nipple fissure
• Thought to be associated with deep, shooting pains
and nipple discomfort
• Most commonly treated with fluconozole to ♀, oral
nystatin to infant
 Breast abscess
A breast abscess is a painful build-up of
pus in the breast caused by an infection.
It mainly affects women who are
breastfeeding.
 Treatment
• Supportive Therapy
• Rest, fluids, pain medication, anti-inflammatory agents,
encouragement
• Continue breast feeding
• Antibiotics that cover Staph and Strep
• Culture results
• Severe symptoms
• Nipple fissure
• No improved sx after 12-24 hours of milk removal
 Treatment
• Dicloxicillin 500 mg qid
• Erythromycin if PCN allergic
• If resistant to treatment penicillinase-
producing staph, then vancomycin or
cefotetan until 2 days after infection subsides
• Minimum treatment 10-14 days
Granulomatous Mastitis
• Noncaseating granulomas in a lobular distribution
• Differential Diagnosis
• TB mastitis
• Foreign body
• Fat necrosis
• Autoimmune: sarcoid, erythema nodosum, polyarthritis
• Presentation
• Unilateral Breast lump
• No infection identified at presentation
Granulomatous Mastitis
• Can mimic Breast Ca on clinical, radiological, and cytological
exams
• Diagnosis: Histology
• Treatment:
• Antibiotics not helpful
• Corticosteroids
• Excision biopsy
 Subclinical Mastitis
• No symptoms, usually unilateral
• Reduction in milk output
• Diagnosis: Increased milk sodium
• Causes
• Milk stasis, poor nutrition, +/- bacteria

• Public Health implication

• Poor infant growth
• Increased risk of HIV transmission

• Natural Hx and clinical implication unclear

 Effect on Milk
Immune Factors
• IgA is predominant in milk
• Increased immune factors from both plasma and local
epithelial cells
• No adverse events documented in peds
• Poor growth documented likely related to poor milk production
• Contradictory studies showing benefit or harm

• Interest in pediatric vaccine development

• Mastitis can decrease motivation to
breast feed
• OK to Breastfeed (except HIV+)
 Increased HIV transmission
risk
• Milk VL increases 10-20 fold
• Alternating breast/bottle increased risk
• Role of free virus vs cell bound virus unclear
• If ♀ must breast feed, then pump on affected breast (pasteurize)
and feed on unaffected
• Subclinical mastitis: Problem -Lab dxs only
Breast Cancer in Pregnancy
• More progressive
• Non Hormonal
Dependence
• Young Patient
• Worst prognosis
• Problem in diagnosis
 Therapy
• trimester
1st
: Operation +Chemotherapy
in 2nd trimester
• 2nd & 3rd trimester : Operative +
Chemotherapy
• After delivery: Radiotherapy
• Termination of pregnancy : Not indicated