Mastitis is an acute inflammatory disease of the mammary gland that occurs predominantly in women (but can also occur in children and men).
For the most part, mastitis occurs during the breastfeeding period, although the disease may develop in nulliparous, non-nursing women, and even in men.
Separately allocated mastitis newborns.
Mastitis is aseptic (purulent) and purulent.
The first is caused by injuries of the breast, stagnation of milk in lactating women without infection of the breast tissue by microbes.
Purulent form occurs as a result of penetration into the breast tissue and ducts of pathogenic flora – staphylococcus, streptococcus and other disease-causing agents.
The penetration of microbes into the mammary gland can occur:
- exogenously (outside) through nipple cracks, skin defects (primary mastitis),
- endogenously, it is a drift of infection into the mammary gland with blood or lymph from other foci of infection (secondary mastitis).
The reasons for the overwhelming number of episodes in the postpartum period are a violation of the breastfeeding technique, milk stagnation ( lactostasis ), nipple cracks and a decrease in immunity, a violation of the normal hormonal balance.
For the most part, mastitis occurs during lactation, if a woman has difficulty breastfeeding.
Often this is due to the following factors:
- rare regime feedings,
- improper attachment of the child, resulting in nipple cracks,
- incomplete emptying of the mammary glands,
- wearing tight underwear that squeezes the ducts
- violation of personal hygiene.
Milk in the ducts is a breeding ground for germs entering the breast. Usually mastitis develops for 3-4 days from the beginning of lactostasis (milk stagnation), if it is not recognized in time and eliminated. But the size of the breast, contrary to popular belief, does not affect the development of the disease.
Mastitis in lactating ( lactational mastitis )
Usually manifested by tightness in the chest, soreness and a feeling of fullness. Against the background of these phenomena, the temperature rises and the general state of health can be disturbed. When lakstostasis not eliminated within 1-2 days, signs of aseptic (non-purulent) mastitis appear:
- soreness in the gland
- diffuse or focal redness
- the temperature of the gland rises to 37-38 degrees,
- difficulty in outflow of milk.
With the progression of mastitis and the addition of infection appear:
- purulent foci, felt under the skin as areas of compaction with the movement of fluid in the center,
- sharp pain,
- discharge of greenish yellow pus from the nipple,
- a sharp rise in body temperature to 39-40 degrees
- symptoms of intoxication
- temperature increase in the zone of the chest itself.
Attention! When breastfeeding, the temperature in the armpits is not measured, it will always be too high, the true body temperature will be the temperature measured in the popliteal fossa or elbow bend.
Not lactational mastitis (in men and women)
It usually manifests itself after injuries or piercings, in case of infection on the gland tissue.
Signs of such mastitis:
- breast tenderness
- the presence of severe redness
- discharge of pus from the nipple,
- temperature rise,
- inflammatory changes in the blood.
Mammologists, gynecologists and surgeons are engaged in the diagnosis and treatment of mastitis.
Mastitis proceeds in stages and it is necessary to recognize it in its early stages. This allows non-surgical treatment methods.
Basically, the diagnosis is made on the basis of clinical data, they are complemented by a blood test with inflammatory changes and data of ultrasound examination of the breast.
At the same time find infiltration (in this case, looking like a seal) or purulent foci ( abscesses ). To establish the microbe, guilty of mastitis, sow milk (or purulent discharge) with the definition of antibiotic sensitivity.
With early recognition of mastitis, it can be cured without surgery.
Treatment of lactational form of mastitis
In this case, it is recommended to follow the following principles:
- to establish a full-fledged outflow of milk from the breast, whether it is a baby sucking or pumping, with milk stagnation, treatment will be of little effect,
- it is necessary to expand the ducts before feeding (warm shower, a glass of warm liquid, warm compress), and after feeding – a cool compress,
- in case of termination of feeding – dimethyl solution sulfoxide at a dilution of 1: 5, topically on the affected gland as a compress
- With the development of non-infectious mastitis with a preventive purpose, antibiotics, anti-inflammatories and antipyretic drugs are prescribed as needed.
If decanting is not possible and there is a need to inhibit lactation, use drugs – cabergoline 0.25 mg 2 p / day for two days, bromocriptine 0.005 g 2 p / day for 4-8 days
Antimicrobial therapy with continued breastfeeding – semi-synthetic penicillins, cephalosporins: cephalexin 5 00 mg 2 r / day , cefaclor 250 mg 3 r / day , amoxicillin + clavulanic acid 250 mg 3 r / day (in case of refusal of feeding you can use any antibiotics)
It would be completely wrong to prohibit breastfeeding, since the baby empties the ducts most effectively. Even if the milk is not sterile, the acidic environment of the child’s stomach will neutralize germs.
Temporarily can be imposed a ban on breastfeeding only with purulent mastitis (abscess), and then only with a sore chest.
With the expiration of pus, powerful antibiotics are prescribed orally or injections.
If an abscess has formed in the chest , this is a direct indication for surgical treatment. A doctor under local or general anesthesia makes a neat incision on the skin and underlying tissues, sucks pus from the cavity and drains it with antiseptic treatment. In the postoperative period, the treatment principles described above are also relevant. Without normal milk flow, lactational mastitis will recur.
Mastitis is not a contraindication to breastfeeding, and certainly not a reason to take drugs to suppress lactation! Taking antibiotics is not an indication to stop breastfeeding, antibiotics are selected compatible with breastfeeding.
Non-infectious Mastitis Therapy
Such mastitis is treated according to general principles:
- antibiotic therapy in the initial stages,
- during the formation of purulent foci – opening them with drainage and washing of antiseptics,
- wound treatment
- use of immunomodulators, vitamins,
- as the manifestations subside, physiotherapy is prescribed to resolve the inflammatory foci.
The basis of its prevention is proper breastfeeding.
It is based on the following principles:
- feeding at the request of the baby,
- adequate breast hygiene (the use of zelenka is usually ineffective), a regular daily shower is enough,
- correct breast grabbing by a baby
- selection of comfortable linen,
- no additional pumping unnecessarily.
- Seek help and advice from breastfeeding counselors immediately upon the formation of lactostasis , breast lumps, and with the slightest doubt.
Performing the following procedures will minimize the risk of its occurrence:
- respect for the area of the mammary gland without injuries, punctures and blows to the chest,
- personal hygiene,
- regular examinations of the tissues in the gland area in order to identify seals,
- taking hormonal drugs only on prescription.