Mastitis is an infection of the breast, most frequently endured by nursing mothers. It can also occur unrelated to gestation or breastfeeding. It's caused by bacteria entering the nipple, generally from the baby's nose or throat, that causes inflammation of the mammary glands. This inflammation can spread through the entire breast, and the bacterial infection can enter the bloodstream.
The most common bacteria are Staph aureus, epidermidis, and Streptococci. Bruising of the nipple, blocked milk ducts, poor letdown, tight bras, long intervals between breastfeeding (such as while weaning), or a previous history of mastitis while breastfeeding are risk factors. Symptoms include the breast(s) becoming red, swollen, hot, painful, nipple cracks, and enlarged lymph nodes of the underarms. They may also report fever, flu-like symptoms, and hard lumps.
Abscess formation, rash, and milk stasis are complications of mastitis. If an abscess is present, a incision may be made to drain it. Rash can occur with infants. Milk stasis is when milk isn't fully drained, and it seeps into the surrounding breast tissue causing pain and inflammation.
A breast ultrasound may be performed to determine if there's an abscess or mass present. Treatment includes warm soaks, loose bras and shirts, continuation of breastfeeding to help engorgement, antibiotics, and pain medication. Make sure to wash hands and breasts thoroughly before and after nursing.
Over-the-counter antibiotic ointment can be applied to cracked nipples but must be washed off before nursing. Medical-grade modified lanolin can be applied to the nipple and doesn't need to be washed off before feeding. Hydrogel dressings are designed for nipple healing but may require a prescription. If you have an abscess, you may need to use a breast pump until you heal. Suckling the baby when you have mastitis won't hurt the baby, as he is the source of the infection. Following up with a lactation specialist is a good idea. Preventing mastitis from recurring includes fully emptying the breasts to help milk stasis. Alternate feeding positions, and rotate pressure areas around the nipple.
The baby should be properly positioned with the entire areola in the mouth. Expose sore nipples to the air as much as possible. Drink plenty of fluids and eat a healthy diet. Take a warm shower, allowing warm water to hit the breasts, and massage the breasts in a downward broad motion to help with draining the milk. The importance of hand and breast washing cannot be overstated. It will help prevent bacteria at the surface of the skin from entering a cracked nipple.
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