Lactation mastitis

Lactation mastitis affects approximately 2 to 20% of breast-feeding people and is defined by inflammation of the mammary gland.

Symptoms associated with lactation mastitis include: pain, erythema, induration, and swelling. 

During pregnancy and lactation, the glandular portion of the breast proliferates, and the epithelial cells undergo a transformation into a secretary phenotype.

With nipple stimulation, oxytocin and prolactin levels rise; oxytocin causes milk ejection for immediate feeding, and prolactin stimulates milk secretion for maintenance of lactation.

Paracrine control of milk production is mediated by substances produced by local epithelial cells, such as alpha – lactalbumin. 

Local feedback, inhibition of milk, secretion decreases milk production when alveolar cells are distended and the memory gland involutes when milk production ceases.

Lactation mastitis, maybe infectious or not infectious and presents with unilateral breast pain, warmth, and erythema.

Risk factors include infection, inflammation, alteration in intrinsic bacterial microbiome.

Lactation mastitis is associated with nipple injury, breast-feeding difficulties, hyperlactation, breast pump use, and a history of mastitis.

These breast symptoms may be localized or involve the entire breast.

Approximately 3 to 11% of patients with mastitis develop an abscess. 

The most common symptoms of lactation mastitis are: malaise (87%), fever (82%), and chills (78%).

Differential diagnosis of lactational mastitis: breast engorgement, focal dict narrowing and stromal edema, galactocele, malignancy or periductal mastitis.

Management: antibiotic treatment and frequent breast emptying to prevent milk stasis, the accumulation of milk in the breast.

Some patients may not require antibiotics and include those with mild symptoms, focal breast, findings, and signs of improvement without antibiotic therapy within 24 to 48 hours.

Conservative therapy consists of physiologic breast-feeding/milk, expression, nonsteroidal anti-inflammatory drugs, and monitoring for symptom progression.

Attempt to keep the breast continually drained, may lead to hyperlactation, pain and more complications, such as, recurrent mastitis and abscess. 

Excessive use of the breast pump can lead to nipple trauma. 

Warm or cold applications may provide symptomatic relief.

Breast massage has limited efficacy.

The most common bacterial agents that causes lactational mastitis include: staphylococcus, particularly S, aureus, and Streptococcus.

Standard anabiotic treatment: dicloxacillin or cephalexin for 10 to 14 days.

Patients who develop abscesses, as demonstrated by ultrasound, should have percutaneous drainage.

Operative incision and drainage of abscesses are rarely required.


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