What is Mastitis? Explanation of Types, Symptoms, and Prevention Methods of Mastitis【Supervised by doctor】

Introduction

This article explains the following information:

• Types of Mastitis
• Symptoms of Mastitis
• Preventive measures for Mastitis
• Timing to visit the hospital

It’s important to note that attempting to treat Mastitis solely based on personal judgment without proper medical consultation can lead to worsening of the condition or prolonged recovery.

However, just being aware of coping strategies and preventive measures can reduce the risk of developing Mastitis. It may also help prevent recurrence, thereby alleviating some stress associated with childcare.

For those who may feel a lump in the breast but are unsure if it’s Mastitis or when to seek medical attention, the information in this article can be helpful.

What is Mastitis?

Mastitis is a condition where inflammation occurs in the mammary glands of the breast, and it commonly affects women during the lactation period. It tends to occur around 2 to 3 weeks after childbirth, with an incidence rate ranging from 2% to 33%.

There are two main causes of mastitis: “milk stasis” and “bacterial infection.”

Milk stasis occurs when breast milk remains stagnant within the breast. Breast milk provides an ideal environment for bacterial growth. When milk remains stagnant in the breast, bacteria can multiply, leading to inflammation of the mammary glands as the body tries to eliminate the bacteria.

Bacterial infection occurs when bacteria from outside the body enter the mammary glands and proliferate for some reason. In response to the proliferation of bacteria, the infected mammary glands become inflamed as the body tries to eliminate the bacteria.

Mastitis can be prevented by maintaining proper breastfeeding techniques and adopting healthy lifestyle habits. By practicing the preventive measures mentioned below, you can prevent the onset or recurrence of mastitis.

Types of Mastitis

The majority of cases of mastitis occur during breastfeeding, but there is still a risk of mastitis outside of the lactation period.

Understanding the types of mastitis can make it easier to determine which type you may be experiencing. Additionally, this knowledge can provide support for more effective preventive and coping strategies.

Inflammation during Lactation

Mastitis can manifest as either lactational mastitis or purulent mastitis. Lactational mastitis occurs when milk flow becomes obstructed, leading to a blockage in the mammary gland where bacteria can proliferate, causing inflammation. Purulent mastitis, on the other hand, is caused by bacterial infection from outside the body.

Both lactational mastitis and purulent mastitis are caused by bacteria, but they are named differently due to differences in treatment methods and symptoms.

Lactational Mastitis

Lactational mastitis is more common in primiparous (first-time) mothers or older mothers. Milk stasis refers to the stagnation of fluid flow.

The cause of lactational mastitis is when breast milk remains stagnant within the mammary gland for an extended period. This stagnation can occur if the pathways for milk flow are not adequately open or if the baby’s sucking strength is weak, leading to milk stasis. Additionally, this condition can sometimes contribute to the development of purulent mastitis, as mentioned later.

The initial symptoms include:

• Lump in the breast
• Redness of the skin
• Sensation of heat (feeling warm or hot in the affected area, even without fever, indicating inflammation)

Symptoms of worsened lactational mastitis include:

• Increased breast swelling and pain
• Discharge from the nipple
• Fever
• Headache and joint pain

It’s not recommended to stop breastfeeding due to pain. Breastfeeding can help alleviate milk stasis because when breast milk is expressed during breastfeeding, it can help resolve the blockage.

The treatment for lactational mastitis aims to improve milk stasis. Specific methods include thorough expression of milk after breastfeeding and appropriate massage. Additionally, symptomatic treatment such as using anti-inflammatory medications or applying ice packs or warm compresses to the breast can help alleviate pain.

Purulent Mastitis

Mastitis occurs due to the invasion and proliferation of bacteria within the breast tissue. If there are wounds or cracks on the nipples, it becomes easier for bacteria to infect through those openings. Staphylococcus aureus and Streptococcus are known bacteria that can easily cause purulent mastitis.

The symptoms of purulent mastitis include:

• Lump or swelling in the breast
• High fever (accompanied by chills or shaking)
• Swelling and pain in the axillary lymph nodes

Regarding the treatment of suppurative mastitis, it is necessary to consult with a doctor as antibiotic administration may be required. Additionally, antipyretics may be prescribed to alleviate pain and fever.

Inflammation outside Lactation

The non-lactation period refers to times other than breastfeeding, such as when pregnant or not breastfeeding after childbirth.

During the non-lactation period, mastitis can cause lumps and pain in the breast, similar to mastitis, making it easy to confuse with breast cancer.

Breast cancer differs significantly from mastitis in terms of risk and treatment methods. If you experience suspicious symptoms, seek medical attention promptly.

Subareolar Abscess

Subareolar abscess is a condition where suppurative mastitis worsens and pus accumulates. Besides bacterial infection, smoking is also suspected as a contributing factor to its onset.

Depending on where the abscess forms, there are superficial and deep subareolar abscesses. Superficial ones are visible on the surface of the skin, and the skin around the breast appears dark purple. On the other hand, deep ones are not visible because they are inside the skin. Deep abscesses are confirmed and diagnosed through breast ultrasound examination.

Symptoms of both types of subareolar abscess may include:

• Redness and swelling around the nipple
• Sensation of heat
• Pain
• Pus discharge from beneath the nipple

Treatment for subareolar abscess typically involves antibiotic administration and surgery. Surgery involves incision or needle aspiration to drain the pus and prevent bacterial reinfection with antibiotics.

Subareolar abscesses tend to recur and can be challenging to fully cure. It’s essential to discuss treatment options thoroughly with a doctor.

Granulomatous Mastitis

Granulomatous mastitis is a condition characterized by the formation of nodules in the breast. Nodules refer to the phenomenon where granulation tissue forms within the mammary ducts.

The exact cause of granulomatous mastitis is unknown.

Symptoms include:

• Ulceration of the skin
• Redness
• Pain
• Indistinct, unilateral, solitary tumors
• Enlarged axillary lymph nodes

Because the imaging findings closely resemble those of breast cancer, differentiation can be very challenging. According to diagnostic criteria proposed by Carmalt et al. in a paper published in 1981, granulomatous mastitis is suspected in the following cases.

1. More common in women of childbearing age within 5 years after their last childbirth.
2. Granulomas accompanied by infiltration of epithelioid cells, neutrophils, lymphocytes, and foreign body-type or Langhans-type giant cells.
3. Presence of abscesses, often formed at the center of granulomas.
4. Lesions primarily located in the center of lobules.
5. No case of caseous necrosis, and the presence of acid-fast bacteria or fungi is denied.

Reference: J-STAGE – “Four Cases of Granulomatous Mastitis”

Treatment typically involves administration of antibiotics and steroid medications, with surgical intervention being considered if symptoms do not improve.

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Mastitis and Inverted Nipples

Inverted nipples are often associated with conditions that can lead to mastitis, such as “milk stasis” and bacterial infections.

Inverted nipples are a condition where the nipple retracts inward towards the body. This can occur when the growth of the milk ducts does not keep pace with the growth of the breast. Underdeveloped fibrous tissue that supports the nipple is also a contributing factor to inverted nipples.

Inverted nipples can accumulate waste more easily. Compared to nipples that are not inverted, the environment can become unhygienic, making it easier for bacteria to proliferate and increasing the risk of bacterial infections causing mastitis. Inverted nipples can also lead to milk stasis, increasing the likelihood of developing lactational mastitis.

To address this issue fundamentally, it may be necessary to use devices to draw out the nipple or undergo surgery.

Suspecting Mastitis?

Early symptoms of impending mastitis may include a sensation of blocked milk ducts. Similarly, if you experience breast pain or fullness, it could indicate the onset of mastitis.

When you feel a blocked milk duct, ensure your baby latches firmly during breastfeeding. Additionally, massage and expressing milk are recommended.

Expressing milk involves manually or with a pump removing milk from the breast. This not only helps prevent mastitis but also serves to build up a supply of breast milk. The specific method for expressing milk can be done manually or with the use of a breast pump.

As symptoms worsen, you may experience fever and intense pain. In such cases, seek medical attention promptly.

When to Visit the Doctor

If you experience the following symptoms, it is recommended to seek medical attention promptly:

• Severe and unrelieved pain
• Fever (accompanied by chills or shaking, or a temperature of 38°C or higher)
• Redness and swelling of the breast
• Swollen lymph nodes under the arm
• Bloody discharge from the nipple
• Inability to breastfeed due to pain
• Recurrence of mastitis

Even if the symptoms are mild, it’s important not to attempt massage or expression on your own but to seek medical consultation. This is because accurately identifying the cause is necessary for efficient treatment of mastitis.

When mastitis worsens, it can lead to sepsis, requiring appropriate treatment such as medication therapy or surgical incision and drainage.

Sepsis is a condition where a bacterial infection causes inflammation throughout the body, leading to organ failure or shock. If mastitis is caused by a bacterial infection, the bacteria can spread beyond the breast tissue and into the bloodstream, causing sepsis.

Treatment involves administration of antibiotics and fluid therapy. In extremely rare cases, mechanical ventilation or dialysis may be necessary.

Preventing Mastitis

The methods explained below are aimed at preventing milk stasis and bacterial infection:

Preventing mastitis not only reduces symptoms such as pain and fever caused by mastitis but also reduces stress in childcare.

Prolonged stress in childcare can lead to conditions such as depression, anxiety disorders, and stress-related physical symptoms. Moreover, stress-induced sleep deprivation can weaken the immune system, making one more susceptible to infections and illnesses.

By implementing preventive measures, we can reduce the risk of stress in childcare and its associated consequences.

Performing Massage

The purpose of massage is to facilitate the passage of breast milk through the milk ducts and to facilitate the expulsion of breast milk and the removal of lumps. Mastitis is a common condition during breastfeeding, but massaging the breasts and nipples during pregnancy is also effective in preventing skin problems such as smooth breastfeeding and nipple cracks. When massaging during pregnancy, always consult your doctor and start after 37 weeks of pregnancy. If you are scheduled for a cesarean section, please refrain from massaging.

There are no specific regulations for how to massage to remove breast milk or lumps, but the Mastitis Care Guidelines include descriptions of massage techniques for mothers by midwives. When massaging yourself, follow the guidelines’ methods.

The areas to focus on for breast massage are as follows:

• The nipple, areola, and the tissue below them (nipple-areola complex)
• The mammary gland parenchyma, mammary gland adipose tissue, and posterior breast fat including the mammary gland body
• The posterior surface of the mammary gland body and the boundary portion with the pectoralis major muscle

Wrap both breasts gently with both hands, applying slight pressure to the entire breast or specific parts. When massaging the parts connected to the muscles deep in the breast, move the breast laterally or lift it slightly.

During the massage, consider the following:

• Perform the massage if there is breast pain or tenderness
• Perform the massage before breastfeeding to facilitate milk expression
• Gently press the entire breast with the palm of your hand
• Move in circular motions from the outer to the inner side of the breast
• Trace from the area far from the nipple to the closer area with your fingers
• Focus on massaging any painful or hard areas
• Continue massaging until the pain subsides

Maintaining Nipple Hygiene

Keeping the nipples clean is important to prevent bacterial growth and reduce the risk of infection.

Using nipple cream can help prevent bacteria from invading and proliferating. Some nipple creams allow breastfeeding without the need to wipe them off, so it’s advisable to use them regularly.

Additionally, changing underwear and breast pads frequently helps maintain cleanliness around the nipples.

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Revising Dietary Habits

“Consuming fatty foods or sweets makes you more prone to mastitis” is a misconception. There is no direct evidence linking food to mastitis.

What’s important is to have a balanced diet. During breastfeeding, an extra 350 to 450 calories of energy are needed compared to before pregnancy.

Furthermore, there is a relationship between a mother’s diet and the composition of breast milk. Particularly, fatty acids, proteins, minerals, and other nutrients in breast milk are said to be influenced by the mother’s diet. Essential nutrients include iron, vitamin C, folic acid, among others, which are crucial for the baby’s growth and immune system. During breastfeeding, strive for a well-balanced diet.

Reviewing Breastfeeding Methods and Timing

The reason for reevaluating breastfeeding methods and times is to prevent milk stasis. By removing breast milk, you can prevent mastitis caused by stasis.

Massaging before breastfeeding or changing the baby’s position can help smooth the flow of breast milk. If the intervals between breastfeeding sessions are too long, the breast ducts are more likely to become blocked. Therefore, it’s important to adjust the frequency of breastfeeding according to the baby’s growth.

There are checklists in mastitis care guidelines to assess if breastfeeding is going well. Refer to the following checklist and compare your breastfeeding method:

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The reason for reevaluating breastfeeding methods and times is to prevent milk stasis. By removing breast milk, you can prevent mastitis caused by stasis.

Massaging before breastfeeding or changing the baby’s position can help smooth the flow of breast milk. If the intervals between breastfeeding sessions are too long, the breast ducts are more likely to become blocked. Therefore, it’s important to adjust the frequency of breastfeeding according to the baby’s growth.

There are checklists in mastitis care guidelines to assess if breastfeeding is going well. Refer to the following checklist and compare your breastfeeding method.

Signs that breastfeeding is going well 【Proper latch (attachment/sucking)】

• The baby’s mouth is wide open
• The lower part of the nipple, rather than the upper part, is not visible beneath the baby’s chin (indicating that the lower part of the breast is inside the baby’s mouth)
• The baby’s chin touches the breast, the lower lip is turned outward, and the nose is not flattened
• No pain [Signs of a well-latched baby]
• Swallowing sounds are audible, and swallowing can be observed
• Rhythmic sucking continues
• The baby’s hands and arms are relaxed
• The baby’s mouth is moist
• The diaper is consistently wet and heavy at regular intervals (6-8 times/day) [Signs of a mother successfully breastfeeding]
• The breast becomes soft after breastfeeding
• After breastfeeding, the nipple is not compressed (no nipple deformation or whitening, etc.)
• The mother feels relaxed and sleepy

Reference: Japan Midwives Association – Mastitis Care Guidelines 2020

Experiencing Mastitis-like Pain?

Recommend seeking medical attention promptly. Dealing with the situation on your own, whether it’s mastitis or not, can be dangerous.

However, if you can’t go to the hospital right away, please try the following three methods to relieve blocked milk ducts:

• Massage
• Breastfeeding
• Expressing milk

Mastitis, caused by bacterial infection, is treated with antibiotics. However, please do not take antibiotics that you have at home without consulting a doctor. This is because it can strengthen the bacteria and lead to worsening symptoms. Antibiotics should only be used to treat bacterial infections, and it is important to adhere to the appropriate duration and dosage determined by a doctor.

Additionally, there are some fever-reducing medications that should be avoided while breastfeeding. If you want to use antibiotics or fever-reducing medications that you have at home, consult a doctor.

Conclusion

Mastitis is a common condition in breastfeeding women where inflammation occurs in the mammary glands of the breast.

There are several types of mastitis, each with different symptoms and treatment methods. The common causes of mastitis are “milk stasis” and “bacterial infection.”

In the case of “milk stasis,” improvement can be expected by ensuring adequate breastfeeding or performing breast massage.

In the case of “bacterial infection,” if high fever or swelling of the lymph nodes is observed, it is advisable to seek medical attention.

Additionally, to address these causes and prevent mastitis, there are four main strategies:

• Massage
• Keep nipples clean
• Review dietary habits
• Review breastfeeding techniques and timings

If symptoms worsen or do not improve, considering the risk of deterioration, promptly seek medical attention.

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