Mastitis (Breast Infection) Types, Causes, Treatment and Prevention

It is not uncommon for breast-feeding mothers to experience a breast infection. Most of the time these infections affect only one breast at a time. It can occur in as many as 1 in 3 breast-feeding mothers and most commonly in the first 3 months of a baby’s life. Although uncomfortable, these breast infections are not a serious condition. Even men can develop a breast infection although it is rare.

What is Mastitis?

Mastitis is the medical term for inflammation of the breast. Typically there is pain, redness and swelling of the breast. Most acute cases are associated with an infection, especially during the first month of breast-feeding. However, mastitis can occur in women who are not breast-feeding and can even affect men in some rare cases.

Chronic cases may be related to secondary infections often associated with an underlying disorder or obstruction of the breast ductal system known as periductal mastitis. Although mastitis is not a serious condition, complications like a breast abscess can arise in severe cases which are left untreated.

Causes of Mastitis

Since most cases of breast inflammation are due to an infection during breast-feeding (lactation), it can be broadly divided into lactational and non-lactational infections. The bacteria that causes these infections are usually on the skin surface or from the baby’s mouth. Breast-feeding infrequently or not emptying the breast fully during feeds are major risk factors for mastitis.

Read more on common breast-feeding problems.

Mastitis During Breast-feeding (Lactational Breast Infection)

Lactational breast infections usually arise in the first 4 to 6 weeks of breastfeeding. It occurs when fissures and cracks develop on the nipple as a result of breastfeeding and this allows bacteria to invade the underlying tissue. Lactational mastitis is usually a superficial infection and may lead to single or multiple abscesses more often on the periphery of the breast. Single or multiple breast abscesses may form and with diffuse infections that are left untreated, extensive necrosis may occur.

Infection initially involves only one lactiferous duct, associated ductules and glandular lobules. Milk stasis may be one of the precipitating factors and therefore drainage is advised to minimize the risk and severity of lactational mastitis. With time, however, the infection may spread throughout the entire breast. The most common causative pathogen is Staphylococcus aureus followed by Staphylococcus epidermidis and streptococci. Staphylococci tend to cause a more localized inflammation in comparison to the diffused infection seen with streptococci.

Mastitis Without Breastfeeding (Non-Lactational Breast Infection)

Non-lactational breast infections may occur with trauma to the breast, post-operatively, in women with poorly managed diabetes mellitus, HIV infection and even rheumatoid arthritis. The infections are more often seen around and away from the areola (peripheral). However, it is a rare entity compared to acute mastitis associated with breastfeeding (lactational mastitis).

Chronic non-lactactional mastitis may be related to keratizination of epithelium lining the nipple ducts. Keratin plugs block the ducts which leads to inflammation. This is known as periductal mastitis. A secondary bacterial infection and abscess formation may arise. It can also lead to the development of a fistula. This type of mastitis is more often seen in female smokers and associated with conditions like an inverted nipple. Read more on deformed nipples.

Signs and Symptoms

Breast pain, tenderness, swelling and redness of the breast are the more common symptoms and may occur with inflammation with/without infection. In the early stages, women many not experience intense symptoms and simply report discomfort when wearing a brassiere or clothing that is tight.

With infections, other signs and symptoms like a fever, headache and fatigue may be present. Pustular discharge, especially yellow to green discharges that have an offensive odor with/without blood may be seen in acute mastitis. There may also be other types of breast secretions. In the event of an abscess, a localized elevated area that is tender which is red and warm to the touch may be seen.

Treatment of Mastitis

Medical treatment is not always required for mastitis. Supportive measures like emptying the breast fully during feeds and feeding the infant more frequently may be effective. A cold compress or ice pack can help with managing inflammation. Resting is also advised as part of converservative management of mastitis. Breast-feeding should not be stopped if mastitis occurs. In fact, breast-feeding can help reduce mastitis symptoms and help with resolution.

Medication like acetaminophen may be prescribed for pain management and fever. Antibiotics are usually prescribed for the treatment of mastitis although some studies suggest that supportive measures should first be attempted. The antibiotics are usually prescribed as a 10 day course. If an abscess is present then drainage may be necessary.

Prevention of Mastitis

A few simple breast-feeding and lifestyle changes can be effective in both the prevention and management of mastitis. It is always advisable to consult with a medical doctor, preferably a gynecologist, as well as a lactation consultant about preventative measures for mastitis. Antibiotics should not be avoided if prescribed.

• Emptying of the breast during feeds is important in order to prevent overfilling which is a contributing factor to mastitis. The baby should be allowed to feed on one breast until it is empty. Applying a warm compress to the breast before feeding can help to facilitate complete emptying.
• Correct positioning of the baby during feeding is also an important factor. This can help the baby to latch on properly for feeding. Changing the baby’s position during feeding can also be helpful. Seek advice from a lactation consultant if necessary.
• Massage the breasts in between and before feeds. By gently pushing from the engorged area to the nipple can help with moving the milk through the network of ducts. It helps with easier drainage of milk from the breasts during feeds.
• Baby should be placed to feed on the affected breast first, especially when baby is hungry and sucking strongly. Ensure that baby’s head is well supported for easier feeding. Allow baby to feed until completion and do not detach baby from the breast early.
• A supportive bra that is suitable for lactating women should be used. It is important to select the correct size for adequate support and comfort. Tight bras or tight clothing that press on the breast should be avoided.