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Lactational mastitis
Last reviewed: 04.07.2025
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[ Causes lactational mastitis
Most often, the entry points for infection are cracked nipples, milk ducts of the gland during breastfeeding or milk expression (intracancular penetration of the infectious agent). Very rarely, the pathogen spreads from endogenous foci.
Risk factors for lactational mastitis:
- cracked nipples;
- lactostasis.
Cracked nipples can occur due to malformations of the nipples, improper breastfeeding techniques, or rough expression of milk.
Symptoms lactational mastitis
With lactostasis, an increase in body temperature is possible lasting up to 24 hours. If more than 24 hours, then this condition should be considered as mastitis.
Depending on the nature of the inflammatory process, lactation mastitis is divided into:
- serous;
- infiltrative;
- purulent;
- infiltrative-purulent, diffuse, nodular;
- purulent (abscessing): furunculosis of the areola, abscess of the areola, abscess in the thickness of the gland, abscess behind the gland;
- phlegmonous, purulent-necrotic;
- gangrenous.
Depending on the location of the lesion, lactational mastitis can be subcutaneous, subareolar, intramammary, retromammary and total. The clinical picture of mastitis is characterized by: acute onset, severe intoxication (general weakness, headache), increased body temperature to 38-39°C, pain in the mammary gland, which intensifies during feeding or pumping. The mammary gland increases in volume, hyperemia and tissue infiltration without clear boundaries are noted. This picture is typical of serous mastitis. If treatment is ineffective for 1-3 days, serous mastitis turns into infiltrative. Palpation reveals a dense, sharply painful infiltrate and lymphadenitis. The duration of this stage is 5-8 days. If the infiltrate does not resolve during the treatment, it suppurates - purulent mastitis (abscessing).
There is an increase in local symptoms of inflammation, significant enlargement and deformation of the mammary gland. If the infiltrate is not deep, then fluctuation is determined during suppuration. Suppuration of the infiltrate occurs over 48-72 hours. In cases where several infiltrates suppurate in the mammary gland, mastitis is called phlegmonous. Body temperature is 39-40 ° C, chills, severe general weakness, intoxication, the mammary gland is sharply enlarged, painful, pasty, the superficial venous network is well expressed, the infiltrate occupies almost the entire gland, the skin above the affected area is swollen, shiny, red, with a bluish tint, often with lymphangitis. With phlegmonous lactational mastitis, generalization of the infection with the transition to sepsis is possible.
Diagnostics lactational mastitis
Diagnosis of lactational mastitis is based on the following data:
- clinical: examination of the mammary gland, assessment of clinical symptoms, complaints, anamnesis;
- laboratory: general blood test (leukogram), general urine test, bacteriological and bacterioscopic examination of exudate, immunogram, coagulogram and blood biochemistry;
- instrumental: ultrasound (one of the important methods for diagnosing mastitis).
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Treatment lactational mastitis
Treatment of lactation mastitis can be conservative and surgical.
Antibiotic therapy should be started with the appearance of the first signs of the disease, which helps prevent the development of purulent inflammation. In case of serous lactational mastitis, the issue of breastfeeding is decided individually. It is necessary to take into account: the wishes of the mother, anamnesis (for example, a history of purulent mastitis, numerous scars on the mammary gland, breast prosthetics), antibiotic therapy, data from bacteriological and bacterioscopic examination of exudate, the presence and severity of cracked nipples. Starting with infiltrative mastitis, breastfeeding is contraindicated due to the real threat of infection of the child and the cumulative accumulation of antibiotics in his body, but lactation can be maintained by expressing.
If conservative therapy of mastitis is ineffective for 2-3 days and signs of purulent mastitis develop, surgical treatment is indicated. Surgical treatment consists of a radical incision and adequate drainage. Antibiotic therapy, detoxification and desensitization therapy are continued in parallel. Timely surgical treatment of lactational mastitis helps prevent progression of the process and development of SIRS.