mastitis

Mastitis: description

Mastitis is a mastitis. It is caused mainly by bacteria. However, other factors such as lactation during lactation, stress or hormonal fluctuations can also cause a breast infection. Mastitis is almost always one-sided.

Physicians distinguish between puerperal mastitis and non-puerperal mastitis. Mastitis puerperalis is a breast infection that occurs during the puerperal and breastfeeding. It affects about one percent of all women who have recently given birth. Inflammation of the breast (= breast) while breast-feeding is called non-puerperal mastitis.

Occurrence of mastitis

Mastitis is a typical disease of the reproductive woman. Therefore, most often 20- to 40-year-olds get a breast infection. Only ten percent of all cases of non-puerperal mastitis are found after menopause.

Men rarely develop mastitis. The disease can also occur in newborns. In this case, doctors speak of a mastitis neonatorum. It usually develops between the fourth and sixth day after birth.

Mastitis: symptoms

There are a number of typical mastitis symptoms. The signs of mastitis puerperalis differ only marginally from mastitis non-puerperalis. Mostly the breast is swollen and hardened in the inflamed area. In this area also often occurs a significant redness. The inflamed chest feels considerably warmer than the non-affected. Typically, patients experience pain as they scan the inflamed site. A pain in the area of ​​the nipple is considered a possible mastitis symptom.

About half of those affected swell the lymph nodes below the armpit. As a rule, this enlargement is painful. In the case of a breast infection in the puerperium, the patients often additionally suffer from general physical complaints. These include chills, malaise and fever with temperatures above 38.4 degrees Celsius. Those affected feel tired, severely beaten and very ill. The secreted milk is changed. It tastes salty, so many infants refuse to drink at the breast.

Usually, the upper area on the outside of the breast is inflamed. If a mastitis is not treated in time, the inflammation can spread to the entire breast. In some cases, the inflammation capsules. It accumulates a large amount of pus (abscess). Experts call this process abscessing. The abscesses can feel a knot on the patient who gives in under pressure and is very painful. Under certain circumstances, passages form from the abscess to the nipple or to the skin surface. Doctors refer to these tubular connections to the body surface as fistulas.

Breast inflammation in newborns is also associated with typical mastitis symptoms. As with adults, usually only one breast is affected and inflammatory red and hot. Diseased babies often cry because of the pain, especially if the inflamed chest is touched. The mastitis neonatorum is usually preceded by a swelling of the breast. In many cases, milk also comes out of the affected breast, which is also called witch’s milk. Do not try to pressure-drain a child’s breast swelling, as it increases the risk of infection.

Mastitis: causes and risk factors

Bacterial mastitis puerperalis

By far the most common causative agent of puerperal mastitis is the bacterium Staphylococcus aureus. With just under 95 percent, he is significantly more often detected in this breast infection than in non-puerperal mastitis. Less common are other germs such as streptococci, Proteus bacteria, pneumococci or Klebsiella. The pathogens enter the baby’s nose and mouth from the mother or other persons in the immediate vicinity (relatives, caregivers). During breastfeeding, the germs are then transferred to the maternal breast.

Breastfeeding causes small skin tears (rhagades) around the nipple. They are the gate through which the bacteria usually first penetrate the lymphatic channels of the mammary gland. In this case, doctors speak of interstitial mastitis, which means “lying in the interstices of the glandular tissue”. Under certain circumstances, the bacteria also get directly into the milk ducts. This so-called parenchymatous mastitis is mainly favored by a congestion. The milk ducts are then significantly widened by the accumulated secretions and thus more accessible to germs.

Non-bacterial non-puerperal mastitis

In most cases of non-bacterial (abacterial) breast inflammation, a congestion is the direct cause of mastitis. In doing so, the mammary gland produces too much milk that can not drain off quickly enough – for example, because the breast tissue has changed to scar tissue as a result of previous inflammations or injuries. Through the accumulated secretions, the milk ducts (ductus lactiferi) widen and the milk penetrates into the surrounding tissue between the mammary lobes. There, the secretion is fought like an intruder – the chest is inflamed. In the further course germs can settle and multiply in the inflamed breast area. Thus, from an abacterial bacterial mastitis.

High blood levels of the messenger substance prolactin cause an increased milk production. This hormone is responsible for breast growth and milk production. It is produced in the pituitary gland and is normally released during pregnancy and lactation. Outside of this time, stress, thyroid disorders, medications (e.g., metoclopramide) or pituitary tumors can lead to increased release of prolactin. In some cases, the cells of the mammary gland are very sensitive to the hormone. Then even small amounts of prolactin cause the mammary gland to secrete more milk.

Bacterial mastitis non-puerperalis

With a good 40 percent of the germ Staphylococcus aureus is the most common cause of bacterial breast infection outside of breast-feeding. The globular bacterium Staphylococcus epidermidis causes an inflammatory reaction in the mammary gland just as often. The bacteria Escherichia coli, Proteus, Fusobacteria and streptococci are also the cause of non-puerperal mastitis. Much less often does it come in the context of another infectious disease – such as tuberculosis, lues, leprosy, radiation fungus disease or typhoid fever – to a breast infection.

About injuries to the breast and the nipple or small skin tears, the germs get into the breast tissue. There they can settle and multiply. The body’s defense is against the invaders and the chest is inflamed. Spreading of the bacteria via the bloodstream is very rare. Only with additional purulent diseases such as a furunculosis, the risk of germ colonization is increased. Boils are painful, purulent inflammation of the hair root and occur frequently in the chest, neck and groin.

Other mastitis risk factors

There are many factors that may favor non-puerperal mastitis. Women who have already breastfed a child, or who injure themselves on the breast or nipple, are more likely to develop breast infection. But medications can also cause mastitis. Contraceptive pills containing a high proportion of the female sex hormone estrogen (estrogen-based contraceptive contraceptives), sedatives or menopausal (e.g., gynodian) drugs make women more susceptible to mastitis. In addition, there are some breast diseases in which mastitis non-puerperalis occurs more frequently.

An example of this is the so-called fibrocystic mastopathy. Large cavities filled with liquid form in the breast tissue. These cysts are more easily colonized by bacteria. Patients often suffer from cycle-dependent pain in the breasts, say doctors of mastodyne. Particularly large breasts refer doctors as macromastia. Both favor a breast infection.

Even if the nipples turn inside out, the chest becomes more inflamed. Physicians refer to this phenomenon as slippery or hollow warts. Studies have also found that non-puerperal mastitis recurs more frequently, especially in heavy smokers.

Mastitis neonatorum

In the body of some newborns still affect the hormones of the mother – including the milk production stimulating prolactin. In that case, the infant’s breasts may swell and secrete a milky fluid. This secretion is also called witch’s milk. If the witch’s milk builds up, the child’s breast can catch fire, especially when trying to force the milk out. Hormones of the mother cake (placenta) or a direct infection with bacteria can cause mastitis.

Mastitis: diagnosis and examination

A gynecologist can usually detect mastitis quickly. First, he asks about the complaints:

• What has changed on your breast?
• Does your chest hurt?
• Do you feel sick and severed?
• Do you have chills or fever?
• Which medications do you take?
• Have you recently given birth?
• Did you already have a breast infection?
• Do you currently breastfeed?

Complaints during breastfeeding indicate puerperal mastitis. The typical symptoms of redness, overheating and swelling of the breast are easy to detect in the subsequent physical examination. In addition, the doctor will scan the breast and the surrounding lymph nodes. If a swelling in the chest is easy to press in, this indicates an abscess.

imaging

In general, the doctor also examines the breast by ultrasound. This was to detect abscesses in the chest and to better assess the extent of mastitis. Pus lesions appear in the ultrasound image as irregular and dark nodes.

Following treatment with antibiotics, the doctor usually initiates a mammogram. This should rule out a malignant disease of the breast. In particular, if the symptoms do not improve under antibiotic therapy, there is a suspicion of inflammatory breast cancer (inflammatory breast cancer). If in doubt, the gynecologist will use a biopsy to remove a piece of tissue from the breast and examine for a potentially malignant tumor.

Blood sample and smear

In the blood, there are some values ​​that are increased in an inflammation in the body. Typically, the white blood cells are increased and the blood decreases faster, as indicated by the increased blood sedimentation (UCS) level. Above all, however, an increased concentration of the hormone prolactin can be detected by taking blood.

If the nipple separates milk, the doctor can make a smear and check for possible pathogens.

Mastitis: treatment

Mastitis symptoms should be clarified early by a gynecologist. Thus, a so-called melting of the inflammation can be avoided. When melted, the inflamed tissue dies and liquefies. A purulent abscess forms.

Cooling and relieving the chest

In the early phase of mastitis, the cooling of the inflamed breast is in the foreground. Ice bags or quark envelopes are suitable for this. To keep the inflamed chest steady, the bra should sit tight. The high binding of the affected breast additionally relieves the strain. Breastfeeding mothers are advised to empty the breast at regular intervals, for example, by brushing out or using a breast pump. This relieves the glandular tissue.

antibiotics

In case of non-puerperal bacterial mastitis, the doctor immediately prescribes antibiotics. Breastfeeding mothers with mastitis puerperalis, on the other hand, are initially treated without antibiotics. For this, the breast is cooled and relieved. If the mastitis symptoms do not improve within one day, it is most likely a bacterial form of puerperal mastitis. Then the doctor prescribes suitable antibiotics that are compatible with breastfeeding and safe for mother and child.

Breast inflammation – Breastfeeding still possible

According to the current guidelines breastfeeding mothers with mastitis usually do not have to take a breastfeeding break. Only in the case of streptococcal breast inflammation should they stop breastfeeding. Even when taking antibiotics, the child may continue to be given the breast. Antibiotics can only be detected in very small amounts in breast milk. In very rare cases they disturb the intestinal mucous membrane of the child, which can cause diarrhea. An exception are premature babies who are particularly sensitive. With them, the mother should abstain from breastfeeding in the case of bacterial mastitis. Talk to your doctor if you are planning a breastfeeding break. He will advise you on the correct weaning.

Other medicines

Non-bacterial non-puerperal mastitis is usually based on too high a blood concentration of the messenger substance prolactin. In this case, antibiotic therapy is not helpful. Rather, doctors try to inhibit the production of milk by the administration of so-called prolactin inhibitors. In lactating mothers with puerperal mastitis, prolactin inhibitors are no longer recommended today so that mothers can continue to breastfeed their children. Anti-inflammatory drugs (non-steroidal anti-inflammatory drugs) such as ibuprofen help against the chest pain of mastitis.

Abszessbehandlung

If the doctor detects an accumulation of pus on ultrasound, this must be surgically removed. First, the inflamed breast is irradiated with warming red light. This promotes the liquefaction and encapsulation of the inflamed breast tissue. Subsequently, the pus liquid is sucked off with a syringe. For larger abscesses makes the doctor a small incision on the affected breast and rinsed out the pus with a liquid. In particularly severe cases, a small tube is also placed in this surgical procedure. After such a catheter, subsequent pus can drain and the doctor can optionally rinse again.

Mastitis: disease course and prognosis

The prognosis of a breast infection is very good. In some cases, it self-replicates or quickly fades through simple action. Especially with an early and correct treatment with suitable antibiotics mastitis heals quickly. In some breast infections, a purulent abscess forms. This can be either directly under the skin (subcutaneous abscess) or the nipple (subareolar abscess). Lower abscesses or fistulae within the mammary gland usually need to be drained and treated by surgery.

Out-of-breast mastitis may, under certain circumstances, recur again and again, leading to chronic mastitis. Therefore, contact a doctor as soon as you notice the first symptoms of mastitis. The inflammatory process can be stopped early in this way. Take the prescribed medication long enough to avoid recurrence of non-puerperal mastitis. If you stop smoking, you also reduce the risk of breast inflammation.

Proper breastfeeding – prevent breast inflammation

Breast inflammation can never be completely excluded. However, proper breastfeeding reduces the risk of puerperal mastitis. Talk to girlfriends, doctors, breastfeeding consultants and midwives. Books and journals also contain useful information. To effectively prevent sore nipples, which are an ideal port of entry for germs, or to prevent a build-up of milk, which increases the risk of mastitis.

Ensure a relaxed breastfeeding position
Sit or lie down and relax. If you have decided to breastfeed while sitting, your arms and back should be well supported. The baby is lying with her belly on her and his head is bent back a bit to keep his nose clear. Your baby should not fall asleep while breastfeeding, as it will easily injure the nipple and increase the risk of mastitis.

Make sure that the child takes the breast properly
In order to be able to suck properly, the baby must have the nipple together with the areola properly in the mouth. If your child only absorbs part of the wart, it can quickly become sore. The baby’s tongue lies above the lower rack when sucking and the lips are turned outwards. If you want to change position and your child does not let go of the nipple, gently push a finger into the corner of the mouth to release the negative pressure in the child’s mouth.

Take into account the physical characteristics
There are a number of factors that can complicate a proper breastfeeding technique. Flat or inverted nipples of the mother, but also a wrong position of the tongue, a short tongue ligament or malformations of the jaw and palate in the child can hinder breastfeeding. In these cases, pay particular attention to the correct donning of your child.

Cleanse your breasts before breastfeeding
Good hygiene prevents the development of mastitis. First of all, clean your nipples and areolae with warm water. Also, wipe over your child’s mouth before breastfeeding to reduce the number of possible pathogens.

Avoid sore nipples
Small skin tears in the area of ​​the nipples simplify the entry of germs. The current guidelines recommend that you do without paraffin-containing ointments, creams and alcoholic fluids as they can dry out the skin. Let your nipples air dry after breastfeeding. Use nursing pads, change them regularly and pay attention to air-permeable materials when buying.

If you already have sore nipples, there are a number of suggestions for treatment. For example, a few drops of breast milk or pure lanolin (wool wax) have a proven soothing effect. Some recommend breast compresses, applied teabags or a soft laser therapy. However, the efficacy of these procedures has not been sufficiently demonstrated that they are not recommended in the guidelines on treatment. This also applies to the use of Brusthütchen. If the nipples are already very red and painful, the likelihood of mastitis is high. In this case, see your doctor quickly.

Take care after birth to an increased breast swelling

After birth, the blood flow in the breasts increases. In addition, more and more milk accumulates. As a result, lymphatic water and venous blood can be transported away worse. Fluid escapes from the bloodstream, accumulates in the tissue and causes edema. In addition, the messenger oxytocin, which controls the flow of milk, gets harder to its place of action, namely the muscle cells of the mammary glands. Stress, lack of sleep and fears also limit the amount of milk given. Some experts recommend that you cool the swollen breast when you are not breastfeeding, and thus prevent mastitis.

Cabbage leaves, cooling pads or Quarkauflagen have proven. However, the guidelines do not suggest a recommendation for the use of rescuer, acupuncture and special massages. So far, there are no proven studies that can confirm their usefulness. Only the so-called gravure massage can reduce the discomfort of swollen breasts. The accumulated fluid is pressed in the direction of the lymphatic channels in order to achieve a natural drainage. Make sure you have a correct execution. Otherwise, the risk of breast infection is increased by minor injuries.

Ensure a regular milk emptying
In the first few days after giving birth, give your child 8 to 12 times the breast to empty the accumulated milk. If you are not breast-feeding your child, empty their breasts by hand stroking or using a breast pump. Preheat your breasts before breast-feeding or pumping to facilitate milk delivery. With strong breast swelling, the so-called reverse pressure softening technique is helpful. Gentle pressure creates slight depressions around the nipple, making it easier for your child to suck on the breast. Be sure to have the technique displayed by trained professionals such as midwives or lactation consultants. Avoid painful massages or injuries – they significantly increase the mastitis risk.

Keep breastfeeding limited at the beginning
In the first few days, nurse your child only five to ten minutes at a time. This will help you avoid nicks around the nipples and prevent puerperal mastitis. Breastfeeding causes an increased release of the messengers oxytocin and prolactin, which stimulate milk production and milk flow. This produces the mature breast milk after two to three weeks. Then let your child drink one breast empty (about twenty minutes). The other breast will only let you drink and start with this side at the next breastfeeding.

Seek a doctor quickly in case of complaints!
If you are in pain or notice other changes, such as red, hot skin on the chest, contact your gynecologist as soon as possible. Early treatment helps to avoid complications such as abscesses. However, try to continue breast-feeding your baby to avoid a congestion. It increases the risk of breast infection and promotes the access of germs and thus the emergence of a bacterial mastitis.