Symptoms of mastitis and basic approaches to treating the disease

RGMU named after N.I. Pirogov

Lactation mastitis is an inflammation of the mammary gland that occurs in the postpartum period during lactation. According to domestic authors, the incidence of acute lactation mastitis in relation to the number of births ranges from 0.5 to 6% [1].

Etiology and pathogenesis

We summarized the experience of treating more than 3000 patients with acute lactation mastitis. In 57.6% of patients, the inflammatory process in the mammary gland occurred in the first 3 weeks of the postpartum period. Much more often (77.6%) primiparous women suffer from mastitis.

The main causative agent of purulent mastitis is Staphylococcus aureus , which was isolated from pus in monoculture in 90.8% of patients and in association with other microflora in 2.5%.

In this case, the data of milk culture for microflora are, as a rule, identical.

Features of the anatomical structure and a sharp increase in the functional activity of the mammary gland in the postpartum period, as well as a decrease in the immunological reactivity of the body, determine the difference in the clinical picture and course of the inflammatory process in mastitis from those in acute purulent surgical infection of another localization.

The mammary gland has a lobulated structure, an abundance of fatty tissue, many natural cavities (alveoli, sinuses, cisterns), a wide network of milk ducts and lymphatic vessels, which is why the inflammatory process is poorly limited and tends to spread to neighboring areas of the gland.

The serous and infiltrative stages of inflammation quickly turn into purulent ones, and the purulent process itself often takes a protracted course, often complicated by sepsis.

These changes are natural, since they contribute to the long-term coexistence of two genetically different organisms (mother and fetus) and ensure the normal course of pregnancy and childbirth [2]. All indicators of the immunological reactivity of the postpartum mother’s body are restored by the 7th day after birth.

However, in the presence of extragenital pathology, complications of the normal course of pregnancy or childbirth, even more profound and long-lasting immunological changes occur. In 84.4% of our patients, pregnancy or childbirth occurred with various complications.

When studying the immune system, we found a decrease in functional activity and a decrease in the number of T-lymphocytes. The severity of immune system disorders correlated with the severity of the inflammatory process in the mammary gland.

In 85.8% of cases, mastitis was preceded by lactostasis , which is the main “trigger” mechanism for the development of the inflammatory process in the mammary gland, and with purulent mastitis it was always present.

With lactostasis, the mammary gland increases in volume, body temperature rises, dense enlarged lobules with a preserved fine-grained structure are palpated. At the same time, there is no hyperemia of the skin and swelling of the gland tissue, which appear during inflammation. If lactostasis is not stopped within 3–4 days, then mastitis occurs , since with lactostasis the number of microbial cells in the milk ducts increases several times and, as a result, the threat of rapid development of inflammation is real.

Classification

According to the nature of the inflammatory process, non-purulent (serous and infiltrative) and purulent (abscessing, infiltrative-abscessing, phlegmonous and gangrenous) forms of acute lactation mastitis are distinguished. Depending on the location of the source of inflammation, mastitis can be subcutaneous, subareolar, intramammary, retromammary and total, when all parts of the mammary gland are affected.

Clinical picture

The disease begins acutely. In the first hours of mastitis development, a feeling of heaviness in the mammary gland appears, followed by pain. The patient’s well-being worsens, weakness, body temperature rises to 37.5 – 38.0°C. The gland slightly increases in volume, skin hyperemia is moderate or barely noticeable.

Expressing milk is painful and does not bring relief, the amount of milk decreases. On palpation, pain and moderate infiltration of gland tissue without clear boundaries are determined; its lobules lose their granular structure.

As the process progresses, it moves from the serous stage to the infiltrative stage, when a painful infiltrate with clear boundaries begins to be palpated in the mammary gland. Skin hyperemia does not increase, there is no swelling.

If treatment is ineffective or untimely, after 3-4 days from the onset of the disease, the inflammatory process becomes purulent. At the same time, the well-being of patients significantly worsens, weakness increases, appetite decreases, and sleep is disturbed. Body temperature is often within the range of 38–40°C.

Chills, sweating, and pale skin appear. The pain in the mammary gland, which is tense and enlarged, increases significantly, hyperemia and swelling of the skin are pronounced. The infiltrate is sharply painful on palpation and increases in size.

In the center of the infiltrate there may be an area of ​​softening, and in the presence of a large purulent cavity, a fluctuation appears. Milk is expressed with difficulty, in small portions, and pus is often found in it. The number of leukocytes in a blood test increases to 10,000–20,000, the hemoglobin content of the blood decreases to 80–90 g/l, protein and hyaline casts appear in the urine.

Diagnostics

With severe symptoms of inflammation, diagnosing mastitis is not difficult.

At the same time, due to underestimation of a number of symptoms characteristic of a purulent process and overestimation of the absence of symptoms such as fluctuation and hyperemia of the skin, 13.8% of patients were treated conservatively in the clinic for from 5 days to 2 months after the development of purulent mastitis.

In 9.8% of cases, as a result of long-term antibiotic therapy with existing abscess or infiltrative-abscess mastitis, an erased form of the disease occurs when the clinical manifestations do not correspond to the true severity of the inflammatory process in the breast tissue.

In these cases, the body temperature is normal or slightly increases in the evening, and individual local signs of purulent inflammation are not expressed or absent. However, the mammary gland remains moderately painful both at rest and on palpation, and an infiltrate is detected in its tissues.

From the anamnesis it is possible to find out that in the first days of the disease the body temperature in such patients was high, many had skin hyperemia and severe swelling of the mammary gland. These signs of the inflammatory process were stopped by the prescription of antibiotics, but the infiltrate remained the same size or gradually increased.

In infiltrative-abscess mastitis, which occurs in 53.8% of cases, the infiltrate consists of many small purulent cavities of the “honeycomb” type; the symptom of fluctuation is determined only in 4.3% of patients. For the same reason, during diagnostic puncture of the infiltrate it is rarely possible to obtain pus. The diagnostic value of the puncture increases significantly with the erased form of abscess mastitis.

Treatment

The basis for surgical treatment is the combination of high body temperature and the presence of a dense painful infiltrate in the breast tissue. At the same time, it should be noted that with lactostasis, body temperature can rise to 39–40°C. This is due to damage to the milk ducts, milk absorption and its pyrogenic effect.

Diagnosis of purulent mastitis against the background of severe lactostasis is sometimes difficult. Therefore, in the presence of severe lactostasis, the issue of surgical treatment should be decided within 3–4 hours after careful expression of milk. Before expressing, a retromammary novocaine blockade and an intramuscular injection of 2 ml of no-shpa (20 minutes) and 0.5 ml of oxytocin or pituitrin (1–2 minutes) must be given.

If there is only lactostasis, then after emptying the mammary gland, pain in it disappears, small, painless lobules with clear contours and a fine-grained structure are palpated, and body temperature decreases.

If the duration of the disease is less than 3 days, the body temperature is up to 37.5°, the patient’s condition is satisfactory, the presence of infiltrate within one quadrant of the gland and the absence of other local signs of purulent inflammation, conservative therapy is possible. In the absence of positive dynamics within 2 days. Surgical treatment is indicated for conservative therapy.

If the disease lasts more than 3 days.

Conservative therapy is possible only if the patient’s condition is satisfactory, body temperature is normal, there is an infiltrate occupying no more than one quadrant of the gland, without local signs of purulent inflammation, unchanged general blood test results and negative data from infiltrate puncture. In the absence of positive local dynamics of the process for a maximum of 3 days. from the start of treatment, surgery is also indicated - excision of the non-absorbable infiltrate, in the thickness of which in these cases small abscesses with thick pus are often found.

• Scheme of conservative treatment of non-purulent forms of acute lactation mastitis:
• • expressing milk from both mammary glands (first from the healthy one, then from the patient) every 3 hours;
• • intramuscular injection of 2 ml of drotaverine for 3 days. at regular intervals 3 times a day 20 minutes before expressing milk from the sore mammary gland;
• • daily retromammary novocaine blockades (100–150 ml of 0.25% novocaine solution) with the addition of broad-spectrum antibiotics in the amount of 1/2 the daily dose;
• • intramuscular administration of broad-spectrum antibiotics in moderate therapeutic doses;
• • desensitizing therapy (intramuscular injection of 1 ml of 1% diphenhydramine solution 3 times a day);
• • vitamin therapy (ascorbic acid and B vitamins);
• • semi-alcohol compresses on the mammary gland once a day;
• • if the disease dynamics are positive, one day after the start of conservative therapy, local UHF or ultrasound therapy;
• • you should not apply local cold and warming ointment compresses.

Surgery for purulent lactation mastitis should be performed in a hospital under general anesthesia. When choosing access to a purulent focus, one should take into account the localization and extent of the process, the anatomical and functional features of the mammary gland.

For subareolar mastitis or a central location of the abscess, a semi-oval para-areolar incision 3–4 cm long is made parallel and 1–2 mm away from the edge of the areola (Fig. 1, d). When the purulent focus is localized in the lower quadrants, a skin incision is made 2 cm above and parallel to the lower transitional fold of the mammary gland.

To open an abscess located in the upper outer quadrant or occupying both outer quadrants, an arcuate outer-lateral incision is made along the outer edge of the base of the mammary gland (Fig. 1, e). In case of total or retromammary mastitis, the incision is made along the lower transitional fold of the mammary gland (Fig. 2). After radial cuts (Fig.

1, a–c) there are rough scars that are poorly hidden by clothing, which disrupts the appearance of the mammary gland, and we do not recommend their use.

Rice. 1. Incisions for acute purulent lactation mastitis: a, b, c - radial; g - paraareolar;

d - outer-lateral.

Rice. 2. Incision for total or retromammary mastitis.

After the incision, all non-viable purulent-necrotic tissue is excised, which contributes to the rapid relief of the inflammatory process. The criterion for the usefulness of necrectomy is capillary bleeding from healthy tissues . The cavity is washed with antiseptic solutions and evacuated. Next, a drainage and lavage system (DLS) is applied, consisting of different-sized polyvinyl chloride tubes (micro-irrigator and drainage), which have side holes and are intended for constant drip irrigation of the remaining purulent cavity in the postoperative period with antiseptics and outflow of rinsing fluid (Fig. 3). The position of the tubes in relation to each other can be different depending on the shape and location of the cavity in the mammary gland.

Rice. 3. Schematic representation of the drainage and flushing system.

Performing a radical necrectomy and washing the purulent cavity through the DPS allows the wound to be closed with a primary suture. As a result, in place of the existing purulent focus, a closed cavity is formed, which is gradually filled with granulation tissue. This allows you to preserve the volume and shape of the mammary gland, which is important from a cosmetic point of view. Contraindications to the application of primary skin sutures are the anaerobic component of the infection and an extensive skin defect, which makes it impossible to bring the edges of the wound together without tension.

Rinsing the purulent cavity with an antiseptic solution (sterile 0.02% aqueous solution of chlorhexidine) begins immediately after surgery at a rate of 10–15 drops per minute into a microirrigator through a system for transfusion of liquids. In total, adequate rinsing requires 2–2.5 liters of fluid per day.

DPS is removed from the wound no earlier than 5 days after surgery when the inflammatory process has stopped, there is no pus, fibrin and necrotic tissue in the washing fluid, and the volume of the cavity has been reduced to 5 ml (determined by the amount of fluid introduced into it).

After removing the DPS, rubber strips are inserted into the wounds remaining at the site of the tubes for 2–3 days. The sutures are removed on the 8th–9th day.

An obligatory component of drug therapy in the postoperative period is the prescription of antibiotics and desensitizing drugs . In severe cases of the disease, immunocorrectors are prescribed, passive immunization, correction of metabolic and hemodynamic disorders, and detoxification therapy are performed.

One of the important tasks of the postoperative period is timely relief of lactostasis . Measures should begin during the operation, when, after treating the purulent focus, careful, but not rough, expression of milk is performed.

In the postoperative period, women express milk first from a healthy gland, then from a sick one every 3 hours. The issue of expressing milk more rarely is decided only after lactostasis and the inflammatory process in the mammary gland have stopped.

Indications for interrupting lactation are severe or protracted inflammatory process in the mammary gland, bilateral mastitis, relapses of the disease, the inability to feed the child with mother's milk after her recovery, the mother's urgent request to stop lactation.

Stopping lactation by tightly bandaging the mammary glands is extremely dangerous, since milk production continues for some time and lactostasis always occurs, and impaired blood circulation in the mammary gland contributes to the development of severe forms of mastitis. Lactation during mastitis can be stopped only after lactostasis has been eliminated .

To stop lactation, bromocriptine is prescribed, 1 tablet (2.5 mg) 2 times a day with meals at regular intervals for 10–17 days. In this case, the daily number of pumping should be gradually reduced and by the 5th–7th day of taking the drug, pumping should be stopped.

Milk while taking bromocriptine is not suitable for feeding a child.

Thus, therapy for acute lactation mastitis should be comprehensive, taking into account the nature and localization of the inflammatory process. The psycho-emotional state of women in the postpartum period and the functional characteristics of the lactating mammary glands should also be taken into account.

You can find a list of references on the website http://www.rmj.ru

Literature:

1. Muravyova L.A., Aleksandrov Yu.K. Surgical treatment of lactational purulent mastitis in combination with HBO therapy. Surgery 1982; 5:21–6.

2. Fogel P.I. Features of cellular and humoral immunity during physiological pregnancy. Obstetrics and gin. 1980; 7:6–9.

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Source: https://www.rmj.ru/articles/khirurgiya/Diagnostika_i_lechenie_ostrogo_laktacionnogo_mastita/

Mastitis

Mastitis is an inflammation that develops in the mammary gland. Most often, this inflammatory process occurs in a woman who has recently given birth to a child.

Basically, the infection enters the mammary gland through cracks that appear on the nipples as a result of breastfeeding .

However, symptoms of mastitis sometimes appear in women in the period before childbirth.

Causes of mastitis

Mastitis, the symptoms of which sometimes develop very quickly in a sick woman, is an acute illness. It is classified as a nonspecific pathology.

In the postpartum period, mastitis mainly initially manifests itself as lactostasis . In this condition, the patient already has all the signs of the development of the inflammatory process, and her body temperature increases.

But the attack of microorganisms has not yet occurred. Most often, manifestations of lactostasis occur in the upper outer part of the mammary gland, closer to the armpit area.

Due to the fact that the risk of infection entering the ducts is highest precisely after childbirth, mastitis manifests itself in a woman in the process of establishing breastfeeding. The most common causative agents of this disease are streptococci , staphylococci , and enterobacteria .

In more rare cases, the disease is provoked by gonococci , pneumococci , and a number of anaerobic bacteria . Microorganisms enter the lobules and ducts of the mammary gland, and as a result of their exposure, mastitis develops. Symptoms of the disease most often appear under the influence of staphylococcus.

The disease is dangerous due to the high probability of suppuration of the mammary gland, which ultimately leads to the need for surgery.

Often, drafts, hypothermia, and taking too cold a shower are also prerequisites for the development of mastitis.

Thus, the causes of mastitis should be identified as infection through cracks in the nipples, the development of lactostasis (a condition in which there is a high production of milk in a woman’s body, problems with its normal outflow and, as a result, its delay). Also a provoking factor is a general decrease in immunity .

Types of mastitis

Acute mastitis is usually divided into several different forms. With serous mastitis , a woman’s general health deteriorates significantly, body temperature increases, and milk retention is observed in the mammary gland.

With infiltrative mastitis, an infiltrate appears in the mammary gland of a sick woman, the skin over which noticeably turns red. This formation can later turn into an abscess. Purulent mastitis by a purulent inflammatory process.

With phlegmonous mastitis, a purulent inflammatory process spreads through the tissues of the mammary gland, and with gangrenous mastitis, necrosis occurs in the chest .

Symptoms of mastitis

As mastitis progresses, the breasts become larger in size, the skin on the mammary gland is painful to touch, and it becomes hot to the touch. An abscess can develop directly in the thickness of the mammary gland during mastitis. It is very difficult for a woman with mastitis to breastfeed; pus and blood can often be found in her milk.

During the examination, the doctor finds other signs of mastitis of the mammary gland. Thus, the thickness of the skin of the diseased breast is much greater than the thickness of the same area on the other breast.

In this case, clear differentiation of the elements of the mammary gland disappears. Dilatation of lymphatic vessels is detected in the mammary gland.

Constant nagging pain and noticeable discomfort in the chest significantly worsen the woman’s general condition.

When mastitis passes into the abscess phase , a delimited abscess appears. When an abscess forms, redness is observed, the skin becomes tense, and in some cases there is severe tension of the skin.

With granulomatous mastitis (another name is idiopathic plasmacytic mastitis ), the clinical manifestations of the disease can be different.

Thus, a woman may experience a small lump in the breast, which is local in nature, and pronounced swelling, in which infiltration of the gland as a whole occurs. This disease occurs mainly in women over thirty years of age. It is directly related to childbirth and feeding a child in the past.

In some cases, with this form of mastitis, nipple retraction is observed, in addition, lymph nodes in regional areas may become enlarged.

Diagnosis of mastitis

Both a mammologist and a surgeon can make a diagnosis of mastitis. Diagnosis is quite simple: for this, the doctor interviews the patient and conducts a detailed examination. To exclude the presence of purulent mastitis, an ultrasound examination may be performed.

Treatment of mastitis

First of all, women should be clearly aware that if they develop mastitis, treatment for this disease should begin immediately. After all, the sooner you resort to adequate therapy, the more successful the treatment will be.

Lactostasis in a nursing woman occurs mainly due to poor drainage of milk in the mammary gland. A similar phenomenon can occur both due to certain characteristics of the ducts (sometimes they are especially tortuous and narrow), and due to the method of feeding.

So, when feeding, a child can better express exactly those lobules that are located near his lower jaw. Therefore, in the first days and weeks after the birth of the baby, young mothers are strongly advised to express their breasts very carefully after feeding is completed.

In women with lactostasis, such pumping is the main measure to reduce the risk of mastitis.

When treating mastitis, an important point is the selection of antibiotics . After all, it is necessary to choose a drug that will have minimal impact on the young mother’s body as a whole and at the same time will have the maximum effect in the fight against the infectious agent.

If the causative agent of mastitis is staphylococcus, which happens most often, then the drugs Cephalexin , amoxiclav , flucloxacillin , ciprofloxacin , clindamycin and others are often prescribed to treat the disease.

The course of antibiotic treatment lasts from ten to fourteen days. Doctors strongly advise not to interrupt the course of treatment, even if the patient’s condition has improved significantly. In parallel with antibiotics, the woman is prescribed treatment with immunomodulators , which help eliminate the inflammatory process and at the same time strengthen the immune system.

Antibacterial therapy is also carried out externally, rubbing ointments with an anti-inflammatory effect into the affected areas. In the treatment of mastitis, hot compresses are also applied topically to stimulate increased blood flow in the area of ​​inflammation, which helps fight the infection. A woman with mastitis is strongly advised to drink plenty of fluids.

Therefore, in most cases, surgical treatment is performed immediately. After the operation, the patient's general condition quickly improves.

In addition, other types of therapy are often prescribed for mastitis. This may include taking anti-inflammatory drugs, physiotherapeutic methods, or cooling the breast.

Often, when a woman develops mastitis, the attending physician may advise her to take measures to completely suppress lactation. This approach is advisable if there is a prolonged lack of improvement in the condition during adequate treatment of mastitis.

If all the means for treating this disease are correctly selected, then the patient’s well-being should improve in no more than three days.

If there are no signs of recovery on the fourth or fifth day after the start of treatment, the doctor may advise suppressing lactation and resorting to other mastitis treatment regimens.

Also, a prerequisite for complete cessation of lactation is the development of purulent mastitis in a woman, especially if there is a repeated case of the disease.

Doctors strongly advise stopping breastfeeding even if mastitis occurs in the lower part of the mammary gland. In this place, lactostasis and mastitis rarely develop and indicate that the mammary gland is too sensitive to the effects of infection after childbirth.

Suppression of lactation as a method of treating mastitis is used when a woman has severe standing, which can also occur against the background of other diseases. The severity of the condition decreases when breastfeeding is stopped.

If you have mastitis, you can try to alleviate the patient’s condition with the help of some folk remedies. You can apply a cabbage leaf to the breast affected by mastitis, which helps reduce pain and relieve redness of the skin. First, you need to mash the cabbage leaf a little so that the juice comes out. The cabbage leaf should be applied to the washed breasts for the whole day and pressed with a bra.

To achieve a warming effect, you can apply a honey cake to your chest, which also helps relieve inflammation. To prepare it, you need to mix two parts of wheat flour with one part of buckwheat or linden honey. After mixing the dough well, you need to roll it into a thin cake and apply it to your chest overnight, wrapping it in a warm scarf. In the morning, you need to wash your breasts and wipe them dry.

To relieve inflammation, you can prepare a decoction, which, moreover, has a calming effect on the body. The herbal infusion includes St. John's wort, nettle and plantain leaves, and valerian root. The collection of herbs should be poured with boiling water, steeped and drunk two tablespoons after eating.

It is most important that a woman, with any manifestations of mastitis, immediately consult a doctor, remembering the seriousness of the disease and the likelihood that it can harm both the health of the mother and the condition of the child, causing very serious complications.

The doctors

Medicines

Prevention of mastitis

Also important preventive measures in this case is compliance with all hygiene rules when feeding the baby: the mother should wash her hands and nipples, and be sure to ensure that the baby is applied to the breast correctly. In this case, it is important that the baby completely grasps the nipple and the space around the nipple during feeding.

Experts advise women who are breastfeeding to wear a special nursing bra that optimally supports the breasts.

Complications of mastitis

There are several possible complications of mastitis in women. Women who have had mastitis before may develop recurrent mastitis . Their risk of re-developing the disease increases both during the current breastfeeding and during subsequent pregnancies .

Breast abscess is also a common complication of this disease - it occurs in approximately ten percent of women who have had mastitis. In this case, the disease cannot be cured without surgery.

Also, after previously suffering from mastitis, a woman’s body becomes more susceptible to the manifestation of mastopathy , in particular its nodular form .

List of sources

• Davydov M.I. Clinical mammology. Practical guide. M 2010;
• Mastitis. Causes and management / World Health Organization. - Geneva: WHO, 2000;
• Usov D.V. Selected lectures on general surgery. - Tyumen, 1995;
• Kharchenko V.P. Mammalogy. National leadership. M 2009.

Source: https://medside.ru/mastit

Breast mastitis

Mastitis or breastfeeding is an inflammation of the mammary gland, which is infectious and inflammatory in nature and has a tendency to spread quickly.

Without timely treatment, the inflammatory process ends with purulent destruction of the glandular area and surrounding tissues.

In patients with a severely weakened immune system, mastitis can cause generalization of infection and the development of blood poisoning (sepsis).

Most often, this pathology develops in women from 18 to 35 years old and in 90 - 95% of cases during lactation and 85% of mastitis develops in the first month of feeding. Infectious and inflammatory process of the mammary glands occurs much less frequently in men and children.

Types of mastitis

There are two main types of mastitis:

• Lactation;
• Non-lactational

Lactation mastitis is associated with milk production.

It most often develops in primiparous women, against the background of stagnation of milk and/or cracked nipples and is associated with the occurrence of a persistent inflammatory process caused by pathogenic or opportunistic microorganisms.

The pathological process is usually unilateral, often on the right, but there is a tendency to increase cases of bilateral inflammation, accounting for 10% of all lactation mastitis.

Cases of the development of this pathology in newborn girls are described against the background of the active production of their own sex hormones and/or their entry into the baby’s body through breast milk, which causes physiological engorgement of the mammary glands with the formation of a focus of inflammation that quickly spreads to the glandular tissue.

This is especially dangerous for microtraumas, dermatitis, allergic reactions in the nipple area or other parts of the mammary gland. If any, even minimal, signs of breast inflammation appear in infants, especially in the first month after birth, it is necessary to consult a specialist (pediatrician or pediatric surgeon).

Non-lactation mastitis accounts for about 5% of all cases of this disease and can develop at any age and not only in women. It is most often caused by injury or persistent hormonal imbalance. This type of mastitis develops less rapidly, but has a tendency to become chronic.

Risk factors for developing mastitis

Experts identify the main reason for the development of the disease during lactation - the occurrence of lactostasis due to various factors:

• excessive production of breast milk;
• improper technique or feeding irregularities;
• nipple abnormalities;
• sluggish sucking of the baby;
• other factors.

• Moreover, with the development of lactostasis, an infectious-inflammatory focus is not always formed; for this, the presence of predisposing and provoking factors is necessary.
• Predisposing factors are conventionally divided into local (anatomical and systemic (functional):
• Local:

• mastopathy;
• congenital malformations of the mammary gland (lobules, ducts, nipples);
• scar changes in tissues after previous inflammatory processes, injuries, surgical interventions;
• the presence of benign or malignant neoplasms;
• other anatomical changes in the mammary gland.

System:

• pathological pregnancy (late toxicosis, intrauterine infections);
• difficult childbirth (trauma to the birth canal, manual separation of the placenta, blood loss);
• exacerbation of chronic somatic diseases;
• postpartum depression or psychosis;
• insomnia.

Factors that provoke lactation mastitis include:

• Changes in hormonal levels.
• Decreased immunity.
• Injuries to the breast and nipples;
• Stress.
• Pustular skin diseases (including in children (pyoderma, staphylococcal omphalitis).
• Hidden bacterial carriage of Staphylococcus aureus (nursing mother, maternity hospital medical staff, relatives).
• Failure to comply with sanitary and hygienic standards when feeding and caring for the mammary gland.

Primipara women are at risk of developing lactation mastitis.

It's connected:

• with poor development of glandular tissue that produces milk;
• imperfection of the ducts and nipples;
• lack of feeding experience (violation of the regime, technique, changes in posture);
• there are no skills to properly express breast milk.

Non-lactation mastitis in most cases develops against the background of:

• Persistent decrease in the overall resistance of the body:
  • previous severe infectious processes or viral infections;
  • severe acute somatic diseases or exacerbation of chronic diseases;
  • sudden general or local hypothermia;
  • chronic fatigue syndrome;
  • stress;
  • insomnia;
  • depression;
  • nervous or physical exhaustion.
• Severe hormonal imbalance.
• Breast injuries, nipple microtraumas.
• Malignant neoplasms, including the mammary gland.

The inflammatory process in mastitis is caused predominantly by Staphylococcus aureus or its association with various pathogenic and opportunistic bacteria (most often in combination with gram-negative flora).

Infection occurs:

• contact (through damaged skin of the breast or nipples):
• microtraumas;
• pyoderma, breast boils;
• skin diseases (dermatitis, neurodermatitis or eczema);
• cracks or ulcers.
• hematogenous or lymphogenous route (with blood or lymph flow from other foci of infection).

Causes of mastitis

Mastitis occurs when bacteria damage the breast. It swells, increases in size, is painful, sensitivity increases, the skin turns red, and body temperature increases. The development of mastitis occurs to a greater extent in breastfeeding mothers.

It is more common in women who have given birth for the first time or in the last months of pregnancy. If this mastitis is not of a lactation nature, then it is common among young girls, non-lactating women and newborn children.

The cause of the disease is a staphylococcus infection. There are cases that the breast is affected by E. coli. Bacteria enter the breast through the bloodstream and milk ducts. A common occurrence of mastitis is stagnation of milk in the breast.

If milk does not flow out for a long period of time, then bacteria form. Then the infection that develops there contributes to the inflammatory process, the person becomes feverish, and pus accumulates.

Infection enters the mammary gland as follows:

• the postpartum period is the most common. Received the name lactation mastitis;
• various traumas to the mammary gland and the formation of cracks in the nipples allow bacteria to penetrate inside;
• Penetration of infection from distant formations of purulent inflammation is considered a rare occurrence.

Symptoms of mastitis

Signs of the disease, their changes and progression depend on the form and stage of the disease.

Symptoms of mastitis:

• increase in size and swelling of the mammary gland (two breasts with a bilateral process);
• severe discomfort and chest pain;
• redness of the skin and local swelling over the site of inflammation, pain on palpation;
• enlargement and tenderness of regional lymph nodes;
• general weakness, lethargy, malaise;
• increase in body temperature from 37.5 to 40 degrees Celsius (depending on the stage and course of the disease);
• loss of appetite, nausea, vomiting, headache, dizziness, convulsions, loss of consciousness (with intoxication syndrome and the occurrence of infectious-toxic shock).

Stages of mastitis development

Forms of the disease:

• acute;
• chronically relapsing.

Stages of the disease:

• serous (without infection);
• infiltrative;
• purulent mastitis (abscess form);
• complex destructive forms (phlegmonous, gangrenous).

Serous stage of mastitis

The serous stage of mastitis is practically no different from lactostasis and develops after 2-4 days of milk stagnation in the absence of the correct treatment tactics.

At the same time, in the affected part of the gland (the area of ​​persistent lactostasis), the tissue begins to gradually become saturated with serous fluid and a focus of inflammation is formed without infection by pathogenic microflora.

Therefore, even if the following symptoms appear, gradually worsening over 1-2 days, experts consider the initial stage of mastitis:

• engorgement and swelling of the mammary gland with severe discomfort and increased pain;
• increase in body temperature more than 37.5 - 38 degrees Celsius;
• painful pumping that does not bring relief;
• painful area of ​​compaction, hot to the touch with possible redness of the skin over the site of inflammation;
• gradual increase in weakness and loss of appetite.

The lack of relief from lactostasis and the progression of its symptoms is an indication for immediate consultation with a specialist (general practitioner, gynecologist, surgeon, mammologist). If left untreated, mastitis quickly progresses to the next stage – infiltrative.

Infiltrative stage

The infiltrative stage of the disease is characterized by the formation of a painful infiltrate and its infection with pathogenic microflora.

The duration of this stage depends on the state of the body’s immunological reactivity and the aggressiveness of bacteria (Staphylococcus aureus or its associations with other microorganisms). A rapid transition to the next stage is possible - purulent mastitis.

Purulent mastitis (abscess)

Purulent mastitis (abscess) in most cases develops 4-5 days after the occurrence of a painful infiltrate in the tissues. It is characterized by an increase in all the symptoms of mastitis, both local and general signs.

Signs of the purulent stage of the disease are:

• the presence of a sharply painful compaction, the tissue resembles a honeycomb or a sponge soaked in pus (a symptom of fluctuation is a feeling of fluid transfusion under the fingers or persistent softening of the tissue);
• redness of the skin over the inflammation, expansion of superficial veins;
• enlargement and tenderness of regional lymph nodes on the affected side (axillary);
• there is an increase in body temperature to high numbers (more than 38.5 -39);
• symptoms of intoxication increase (persistent loss of appetite, severe weakness, drowsiness, headaches, nausea, less often vomiting, dizziness).

Treatment for this stage of the disease is only surgical - opening the abscess and draining the cavity. If left untreated at this stage of the disease, mastitis develops into complex destructive forms:

• phlegmonous, which is characterized by the spread of a purulent-inflammatory process to the subcutaneous fatty tissue of the gland and other breast tissue (more than 3 quadrants);
• gangrenous - a particularly dangerous form of the disease involving blood and lymphatic vessels in the process with the formation of blood clots.

Phlegmonous mastitis

With phlegmonous mastitis, there is total swelling, persistent redness of the skin of the mammary gland with a cyanotic (bluish) tint, the breast is sharply painful, and nipple retraction is often observed.

The patients' condition progressively worsens - febrile temperature, weakness, dizziness, complete lack of appetite, convulsions and even loss of consciousness.

When these symptoms appear, immediate hospitalization in the surgical department and active treatment of the disease is necessary.

Gangrenous mastitis

The gangrenous stage is manifested by a total increase in size of the mammary gland and the appearance of areas of necrosis (tissue death) on its surface. This stage often ends with the development of infectious-toxic shock and death.

Complications of mastitis

Any infectious-inflammatory process caused by Staphylococcus aureus can be complicated by the generalization of infection and the development of septic complications:

• bacterial endocarditis or pericarditis;
• meningitis or meningoencephalitis;
• sepsis (presence of multiple purulent foci - pneumonia, meningitis, osteomyelitis, endocarditis);
• infectious-toxic shock;
• DIC – syndrome.

Diagnostics

If signs of mastitis appear and you suspect the development of inflammation of the mammary gland, you must urgently consult a specialist (surgeon).

Clarifying the diagnosis in most cases is not difficult and is determined on the basis of complaints and examination of the affected breast. If necessary, additional examinations are prescribed:

• general blood and urine analysis;
• bacteriological culture of breast milk or nipple discharge;
• cytological examination;
• Ultrasound of the breast (if the development of destructive forms is suspected);
• puncture of the infiltrate (for an abscess or phlegmonous form) with bacteriological examination of pus;
• mammography (when differentiating from ductal or lobular abnormalities and malignant neoplasms).

Feeding for mastitis

It is impossible to feed a baby with a sore breast with confirmed mastitis!!!

Therefore, if any signs of mastitis appear, you should immediately consult a specialist. If unilateral mastitis is confirmed in the serous or early infiltrative stage, lactation can be maintained provided that all specialist recommendations are followed.

It is important to remember that milk from a sore breast cannot be fed to a child, not only because of the risk of infection with pathogenic staphylococcus, but also due to pronounced biochemical changes in the composition of milk, which disrupts the digestive process and causes persistent disruptions in its functioning. Experts recommend expressing milk every 3 hours - first from a healthy breast (after pasteurization it can be given to the baby, but it cannot be stored for long), and then from a diseased breast.

Indications for complete cessation of lactation are:

• Bilateral mastitis;
• Destructive forms;
• Presence of septic complications;
• Recurrent course of the disease;
• Other reasons and desire of the patient (refusal to breastfeeding).

Treatment of mastitis

Conservative treatment of mastitis is prescribed in the serous and infiltrative stages:

• with the general relatively satisfactory condition of the patient, if the duration of the illness is no more than 3 days;
• there are no local symptoms of purulent inflammation;
• body temperature not higher than 37.5 degrees Celsius;
• with moderate pain in the area of ​​infiltration, which is no more than one quadrant of the gland;
• there are no changes in general blood test parameters.

If conservative therapy is ineffective within two days, this is an indication for surgical intervention.

For destructive forms, treatment is only surgical, in a hospital setting, under general anesthesia. Complete cleansing of the opened abscess, excision of non-viable tissue and drainage of the cavity are required.

The extent of surgical intervention depends on the size and course of the abscess. After surgery, a course of antibiotics, vitamin therapy, absorbable and restorative medications are prescribed.

It is important to remember that self-medication (use of warm compresses and ointments) leads to the spread of inflammation and purulent process, the progression of destructive forms of mastitis.

Prevention of masitis

Preventive measures for mastitis include:

• stagnation of milk;
• cracked nipples;
• compliance with sanitary and hygienic standards when feeding and caring for the mammary glands;
• pyoderma and pustular processes in children;
• strengthening the immune system;
• correction of hormonal imbalance;
• injuries and postoperative complications (during plastic surgery);
• stress;
• timely treatment of somatic diseases and exacerbations of chronic pathologies;
• sanitation of foci of chronic infection;
• wearing a bra made of natural fabrics and choosing the correct size of underwear;
• good nutrition and healthy sleep;
• preventive examinations with a mammologist annually after 40 years and timely consultation with a specialist
• when signs of inflammation of the mammary gland appear.

Mastitis is a serious pathology that, if not consulted in a timely manner, can transform into a chronic form or cause life-threatening complications.

Source: https://www.mammologia.ru/zabolevanija/mastit/

Treatment of mastitis

Mastitis is an inflammation of the mammary gland, most often developing in women during lactation. However, it is possible that mastitis may occur on the eve of childbirth, during adolescence or childhood, and even in men.

The causes of mastitis for any category of persons are as follows:

• cracked nipples;
• penetration of a bacterial agent into nipple cracks;
• virus carriage and its spread to the mammary gland;
• any purulent and chronic infections;
• anomalies of nipple development;
• the presence of concomitant extragenital pathology (skin pyoderma, lipid metabolism disorder, diabetes mellitus);
• structural changes in the mammary glands (mastopathy or scar changes);
• hypothermia and drafts;
• low socio-economic level of patients.

The risk group for the development of mastitis includes women who have had diseases of the mammary gland, as well as women in labor with purulent-septic complications that developed during childbirth. Pregnant and breastfeeding women are most susceptible to mastitis, and therefore for this group of women the following factors for the development of mastitis :

• insufficient compliance with the rules of personal and intimate hygiene;
• reduced immunoreactivity of the body;
• complicated childbirth;
• complicated course of the postpartum period and the development of wound infections, delayed involution of the uterus, thrombophlebitis;
• violation of hygiene and rules of breast care, in particular during pregnancy and lactation;
• insufficiency of the milk ducts in the mammary gland;
• impaired lactostasis and milk stagnation as a consequence;
• improper expression of milk.

Medical practice knows cases of the development of mastitis in newborns - the so-called neonatal mastitis.

In infants, mammary glands swell when lactogenic hormones from the mother enter their body.

The entry of hormones into the child’s body is likely through placental blood; the disease develops regardless of the sex of the child. This pathology usually does not require special medical intervention and goes away on its own.

Mastitis is distinguished by its course and origin.

The nature of the inflammatory process allows us to talk about lactation (in lactating women due to disturbances in the lactation process) and fibrocystic mastitis (develops regardless of the presence of lactation).

The course of mastitis allows us to call it:

• purulent,
• serous,
• infiltrative,
• abscess,
• gangrenous,
• non-lactating.

The symptoms of mastitis are very specific. Their occurrence leaves no doubt that problems have arisen with breast health. This:

• pain syndrome localized in the chest and sometimes taking on intolerable forms;
• increased body temperature, sometimes up to 40°C;
• aching bones and headache, general malaise caused by acute inflammation;
• redness and swelling of one or both breasts;
• swelling of the nipples and discharge of purulent or bloody contents from them;
• breast hardening;
• difficulty in the outflow of milk, as well as impurities.

The initial stages of mastitis usually occur with mild symptoms - the temperature rises slightly and there is no severe pain.

This is where the danger lies, since against the background of a latent process, which, hopefully, will go away on its own, there is a risk of developing an abscess, and the lesion can spread to the entire mammary gland with the subsequent development of hypogalactia.

Hypogalactia is the cessation of milk production by the edematous mammary gland. The presence of an abscess makes the gland softer, but breastfeeding is extremely painful and the milk often contains pus. Violation of lactation only aggravates the inflammatory process.

If the doctor determines a borderline state between lactostasis and mastitis (the latter develops precisely as a result of milk stagnation), then the woman is recommended to be monitored over time and certainly use antiseptics.

Subsequently, antiseptic drugs can be replaced with antibacterial or antiviral ones, however, in the case of mastitis development and after analysis of the sensitivity of the bacterial microflora to specific medicinal components.

Infectious forms of mastitis are treated exclusively with targeted antibiotics prescribed by a qualified specialist.

Before prescriptions, the doctor conducts a bacterial culture of the flora, which makes it possible to determine the type and concentration of the pathogen (leukocytes in milk more than 106/ml and bacteria in milk more than 103 CFU/ml).

The decision whether or not to continue breastfeeding while taking antibiotics is made solely by the attending physician.

Acute non-purulent mastitis is not an obstacle to breastfeeding, but you should absolutely not breastfeed if the milk contains pus.

In all cases, local application of cold, physiotherapy and immunomodulators, painkillers (and sometimes novocaine blockade) and anti-inflammatory ointments locally are additionally prescribed. It is necessary to pump every three hours, but this is contraindicated in case of an abscess.

The development of mastitis occurs on the basis of lactostasis, which is the process of stagnation of milk in the breasts of a nursing woman. The cause of lactostasis can be both physiological or hormonal factors, as well as a violation of the feeding regime or systematically incorrect latching of the baby to the breast.

Mastitis in the majority of cases is preceded by pregnancy and childbirth, probably with complications or infection and a natural decrease in immunity during this period.

Mastitis, among other things, can develop as a condition accompanying the following diseases:

Treatment of mastitis can occur at home, but in strict accordance with medical prescriptions. Self-medication of mastitis rarely leads to success, but only takes time and allows the pathological process to become more complicated.

In addition to taking medications and following other recommendations, it is useful to:

• drink a lot of liquid, in particular rosehip decoction, uzvara, warm non-mineral water;
• before feeding - apply warm wet compresses to the chest and dry heat to the neck and shoulders, which helps relieve spasm of the milk ducts and reduce breast swelling;
• after feeding - apply cold dry compresses to the chest.

As part of the prevention of mastitis, it is recommended:

• apply the newborn to the breast correctly;
• breastfeed on demand, not according to a schedule;
• carefully observe personal hygiene and feeding hygiene;
• If cracks form, treat them promptly and correctly.

Strictly contraindicated:

• limit the frequency and duration of feedings;
• express milk unnecessarily, that is, when the baby is sucking well;
• abruptly wean the child off the breast unless the doctor insists on it; For uncomplicated mastitis, feeding promotes recovery.

Antibiotics for oral administration:

• Azithromycin - on the first day, 500 mg is prescribed once, on days 2-5 - 250 mg per day or for 3 days, 500 mg once a day (course dose - 1.5 g);
• Clindamycin - the recommended dose for adults for intravenous and intramuscular administration is 300 mg 2 times a day, and for severe infection - 1.2–2.7 g per day in 3-4 doses;
• Cefaclor - 500 mg 3 times a day, for severe infections - 1 g 3 times a day; the maximum dose is 4 g per day;
• Cephalexin - the average daily dose ranges from 250-500 mg every 6 hours, but should not be less than 1-2 g per day; if necessary, can be increased to 4 g; The duration of treatment is 7-14 days.

To suppress lactation:

• Bromocriptine - the average daily dose ranges from 5-10 mg, determined individually;
• Cabergoline - once on the first day after birth at a dose of 1 mg; to suppress existing lactation, take 250 mcg every 12 hours for two days;
• Quinagolide - once a day, before bedtime; initial dose - 25 mcg per day for 3 days, over the next 3 days - 50 mcg per day, from day 7 - 75 mcg per day; the average dose is 75-150 mcg per day.

Against pain and fever:

• Ibuprofen - dosages are individual, the average daily dose should not exceed 1.2 g per day;
• No-spa - dosages are individual, the average daily dose ranges from 40-240 mg.

Antibacterial drugs for topical use: (rub, consult a doctor)

• Heliomycin,
• Dexpanthenol,
• Etonium.

Anti-inflammatory ointments for topical use: (rub, consult a doctor)

• arnica oil,
• Traumeel S,
• Troxevasin.

The use of folk remedies for the treatment of mastitis should be balanced and certainly discussed with the attending physician. Self-medication with pharmaceuticals and, especially, folk remedies is dangerous due to complications of the infectious and inflammatory process.

Today, the following recipes for folk remedies for the treatment of mastitis :

for oral administration

• 1 tbsp. Brew St. John's wort herb in 300 ml of boiling water, leave for 1 hour with a lid, then strain; take 3 times a day, 1/3 cup;
• 6 tbsp. Brew horse chestnut flowers in 1 liter of water, bring to a boil, leave overnight in a warm place (you can use a thermos), strain in the morning; take 1 sip every hour during the day;

for compresses and lotions

• in case of hardening or inflammation of the breast, it is necessary to apply a steam compress of 6-8 layers of fabric soaked in a very warm infusion of chamomile flowers, leave the compress for 20 minutes, and then be sure to express the stagnant milk;
• 3 tbsp. Brew St. John's wort herb with 3 cups of boiling water, keep on low heat for 10 minutes in a sealed container, when cool, strain; Wash the cracks in the nipples with the resulting decoction, and then lubricate them with St. John's wort oil, apply a dry compress of 4 layers of fabric for 6 hours;  
• mix 1 raw yolk with 1 tsp. honey and 1 tbsp. vegetable oil, add rye flour until a thin dough forms; attach the resulting substance with gauze to the sore spots, change 2-3 times a day, you can leave it overnight;
• crush and moisten the seeds of the plantain with warm water and lubricate the inflamed mammary glands with the resulting substance.

It is strictly forbidden to use folk remedies containing:

• camphor oil (getting into milk makes it unsuitable for consumption by a child);
• alcohol (increases lactostasis).

During pregnancy, mastitis develops much less frequently than during lactation. However, a pregnant woman is still highly susceptible to negative factors and exacerbation of chronic pathologies.

The main difference between mastitis that develops during pregnancy is that with this disease, especially in its purulent forms, there is a real threat of infection of the embryo, and even the threat of termination of pregnancy.

Treatment of mastitis in pregnant women should be timely and as effective as possible. The use of antibiotics, if necessary, should be agreed with the attending physician.

The doctor suspects mastitis at the stage of familiarization with the patient’s complaints and physical examination of the breast. To confirm the diagnosis, a series of studies is necessary:

• Ultrasound of the mammary glands - allows you to examine breast tissue, determine their modifications and the type of mastitis, and exclude complicated mastitis;
• general and biochemical blood test - allows you to detect leukocytosis, indicating an inflammatory process; a detailed hormone analysis may be needed;
• studies of milk microflora and its sensitivity to antibiotics.

It is important to differentiate mastitis from lactostasis, which inherently serves only as a basis for inflammation. Timely response to the presence of lactostasis allows you to exclude mastitis in the future.

Lactostasis is stagnation of milk, in which it is poorly expressed only from a stagnant place.

Lactostasis is accompanied by a low temperature and usually develops on one breast, while mastitis quickly spreads to both.

The information is for educational purposes only. Do not self-medicate; For all questions regarding the definition of the disease and methods of its treatment, consult your doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal.

Source: https://www.eurolab.ua/treatment/197/