Mastitis

Mastitis is an acute purulent inflammation of the parenchyma and interstitium of the mammary gland. By origin, two forms are distinguished: banal mastitis, which develops with damage to the mammary gland - in fact, this is a suppurating "hematoma", observed in 3% of cases; and lactational (postpartum) mastitis, which accounts for 97% of cases.

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Causes mastitis

The development of lactational mastitis can be observed in 0.5-6.0% of women in labor and depends on the measures taken to prevent its occurrence. Most often, one mammary gland is affected; bilateral mastitis is rare. The main reason for the development of lactational mastitis is milk stagnation, its fermentation, followed by infection.

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Stages

In the development of lactation mastitis, it is necessary to distinguish several stages.

The initial (stagnant) phase, which is the trigger for the development of mastitis, is formed with insufficient evacuation of residual milk. The patient is bothered by a feeling of heaviness and distension in the mammary gland, roughened lobules are palpated, pumping is painless and brings relief, no general reaction is noted. If high-quality evacuation of milk is not performed, as a rule, mastitis develops in 2-3 days.

1st - mastitis in the serous inflammation stage - accompanied by sharp pains in the mammary gland, an increase in its volume due to edema, widespread hyperemia, chills and high body temperature, since milk has a pyrogenic effect. When palpated, the breast is hot to the touch, painful, and hardened lobules are determined deep inside. The pathogenetic cause is milk fermentation. Mastitis is reversible. The main condition for treatment is the high-quality removal of residual milk in various ways: with a breast pump, manual expression, and it is possible to recommend milk suction for adults. The child not only can, but should be fed starting from this mammary gland, since there is no pathogenic microflora in the curdled milk yet. But antibacterial drugs that penetrate into milk are prohibited for use, since the child will develop severe dysbacteriosis, or even poisoning. Local treatment involves applying alcohol compresses, corset bandages or wearing corset underwear to improve blood circulation in the mammary glands. If serous inflammation is not treated effectively, infiltration occurs and the process moves to the second stage.

2nd - mastitis in the infiltration stage. Mastitis is practically irreversible, since pathogenic microflora is introduced. There is a decrease in pain, swelling and hyperemia, with a tendency to localization. When palpating deep in the chest, a rounded seal (infiltrate) is determined. It is elastic, dense, painful, mobile, of uniform consistency. Given the presence of pathogenic microflora, the child is transferred to artificial feeding. In this case, a patient with mastitis can be prescribed a full range of antibacterial therapy, physiotherapy, compress bandages with antiseptics. Lactation is blocked with hormonal drugs. But it is very rare to stop the process. Obvious suppuration is formed.

3rd – mastitis in the abscess stage. Pain in the chest increases, becomes “twitching” in nature, the “sleepless night” symptom develops. The swelling decreases, but can be extensive, hyperemia is localized over the abscess.

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Diagnostics mastitis

Palpation reveals sharp pain and softening of the infiltrate, heterogeneity of structure; with extensive abscesses, a fluctuation symptom is noted. At this stage, opening of the abscess is indicated.

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Treatment mastitis

Extremely rare, phlegmonous and gangrenous forms of mastitis may occur, which require radical operations, including mastectomy.