Mastitis During Breastfeeding - Symptoms and Treatment

Puerperal mastitis, also called lactational mastitis or breast-feeding mastitis, is an inflammation of the mammary glands, which occurs in breast-fed women and can cause breast redness, pain, and a high fever.



Up to 10% of women develop at least one episode of mastitis during the breastfeeding period. In most cases, mastitis occurs within the first three months of breastfeeding, but nothing prevents this breast inflammation from occurring in later stages.

Mastitis is caused by a number of microorganisms, and Staphylococcus aureus is the most common agent responsible for more than half of the cases.

The main risk factor for puerperal mastitis is lactic stasis, that is, the presence of damped milk in one of the breast ducts for an extended period of time. Milk stasis can occur due to obstruction of one of the ducts of the breast or incomplete emptying of the breasts by the baby during breastfeeding. Another important risk factor is nipple fissures, which favor the invasion of bacteria from the skin into the breast tissue. Therefore, breastfeeding mastitis occurs primarily when a bacterium coming from the skin can reach a region of the breast where there is milk stasis.

We can therefore conclude that the best way to prevent mastitis in the puerperium is through the correct technique of breastfeeding, with an adequate baby's handhold, aiming at an effective emptying of the breast at each feeding and avoiding the occurrence of nipple lesions that serve as an entrance door for the invasion of bacteria.

The main signs and symptoms of puerperal mastitis are hardening of the breast (sardine milk), local redness, pain, tiredness, chills and fever, usually above 38ºC. At touch, the area of the affected breast is usually hardened, with increased temperature and painful. Breast-feeding mastitis usually affects only one breast, and bilateral infection is rare at the same time.

The picture usually starts mildly, first with the hardening of a breast region, indicating milk stasis at this site. Thereafter, pain and a small local redness may develop. Proper emptying of the breast at this time is important to prevent the progression of inflammation. If stasis persists, there may be local infection, and symptoms of high fever, chills, and prostration will appear.

If not properly treated, breastfeeding mastitis can progress with the formation of abscesses, Making it a serious condition with risk of sepsis and need for hospital admission. If there are signs of breast inflammation, see your gynecologist or your child's pediatrician so that appropriate treatment can be started early.

Due to discomfort, prostration and pain, and also because they believe that breast milk from the inflamed breast is contaminated and will harm the baby, many women will stop breastfeeding early. This procedure is wrong! Suspension from breast-feeding further promotes breast engorgement and bacterial proliferation. Frequent emptying of the breast is essential for successful treatment.

Regarding baby safety, do not worry. Breast milk is very rich in antibodies and antibacterial substances. In addition, the acidity of the baby's stomach is in charge of destroying the bacteria and toxins that are to be ingested. Therefore, breastfeeding during puerperal mastitis is not only permitted, as is fully indicated.

If the baby is restless during breastfeeding in the affected breast, it may be due to some delay in the descent of the milk due to obstruction. Do not take this as a sign that milk is doing harm to the baby. Continue breastfeeding and drain the remainder of the milk with a pump, if necessary after the end of breastfeeding. Massages, compresses or hot baths help in lowering milk.

In milder cases only correct breast emptying may be sufficient to control mastitis. However, when there is a high fever, malaise or prostration, the use of antibiotics is usually necessary.

The most commonly used antibiotics are penicillins or cephalosporins, such as dicloxacillin, cephalexin, or cephradine. Treatment is usually prescribed for 7 to 14 days, depending on the severity of the infection.

The classes of antibiotics suggested above are considered safe during breastfeeding, since the amounts eliminated in milk are minimal and do not cause harm to the baby.

If after 48-72 hours of antibiotics there are no signs of improvement, a breast ultrasound is indicated to rule out the presence of an abscess.

After the picture is resolved, breast-feeding techniques need to be reviewed to minimize the chances of a new episode of mastitis.