Article: Mastitis

Mastitis is the inflammation of the mammalian breast. It is called puerperal mastitis when it occurs to lactating mothers and non-puerperal otherwise.

Mastitis can rarely occur in men.

Inflammatory breast cancer has symptoms very similar to mastitis and must be ruled out.

Chronic cystic mastitis, also called fibrocystic disease, a condition rather than a disease, is characterized by noncancerous lumps in the breast.

Puerperal Mastitis

Caused by the blocking of the milk ducts while the mother is lactating (see breastfeeding). It can cause painful areas on the breasts or nipples and may lead to a fever or flu-like symptoms. Except in heavy cases it is not necessary to wean a nursling because of mastitis; in fact, nursing is the most effective way to remove the blockage and alleviate the symptoms, and is not harmful to the baby. Sudden weaning can cause or exacerbate mastitis symptoms.

Mastitis can be discerned from simple blockages by the intensity of pain, heat emanating from the area, redness and fever in the mother. In some cases the fever can become severe, requiring antibiotics; ten percent of cases develop into abscesses that need to be drained surgically.

Treating puerperal mastitis

Massage and the application of heat can help prior to feeding as this will aid the opening of the ducts and passageways. A cold compress may be used to ease the pain when not wanting to lose the milk, though it is most appropriate to reduce the levels of milk contained. For this reason it is also advised that the baby should frequently feed from the inflamed breast. However, the content of the milk may be slightly altered, sometimes being more salty, and the taste may make the baby reject the breast at the first instance.

The presence of cracks or sores on the nipples increases the likelihood of infection. Tight clothing or ill-fitting bras may also cause problems as they compress the breasts.

In severe cases it may be required to stop lactation and use lactation inhibiting medication.

Nonpuerperal mastitis

Nonpuerperal mastitis is often related to macromasty, mastodyny or mastopathy. Hyperprolactinemia, Thyroid problems, Tobacco smoking, nipple piercings, diabetes and some medications are predisposing factors.

In many cases nonpuerperal mastitis starts as nonbacterial inflammation. Risk of recurrence, abscesses and secondary infection is very high for nonpuerperal mastitis. Once the condition becomes chronic or recurrent it is very hard to treat and frequently requires repeated surgery. Therefore prompt and appropriate treatment by a specialist is important.

Treating nonpuerperal mastitis

Most effective treatment is Prolactin inhibiting medication such as Cabergoline or Bromocriptine. Resolution of symptoms is usually within 2-6 days but treatment must be continued for at least 3 to 6 weeks to reduce risk of recurrence. Some sources recommend up to 6 months of Prolactin inhibiting medication.

Prolactin inhibiting treatment is the most effective method even in cases where Prolactin level is normal, therefore testing Prolactin level before treatment is rarely useful.

Hyperprolactinemia and Thyroid problems should be ruled out following treatment.

In cases of recurrent nonpuerperal mastitis without obvious cause tests for latent hyperprolactinemia (TRH stimulated PRL), Fasting glucose and IGF-1 (Insulin-like growth factor 1) may be useful.

Inflammatory breast cancer

A very serious type of breast cancer called inflammatory breast cancer presents with similar signs/symptoms as Mastitis. It is the most aggressive type of breast cancer with the highest mortality rate.

Therefore if symptoms of Mastitis persist longer than two weeks inflammatory breast cancer must be ruled out.

See also

• Breast engorgement