What is mastitis? What Are Mastitis Symptoms and Treatment

Mastitis occurs as a result of inflammation of the breast tissue, usually in women who are breastfeeding. It can be seen in different forms, from a small, localized rash to a breast abscess. In cases where mastitis affects both breasts, the feeding relationship between mother and baby may be disrupted. However, it is very important for women with mastitis to continue to breastfeed their babies.

What is Mastitis?

What is mastitis? Mastitis is an inflammatory disease of the breast tissue with or without infection, which may present with redness, swelling, tenderness and pain in the breast. The disease can range from a noninfective inflammation to an infectious disease and finally to abscess formation. It is a common health problem in breastfeeding women. This condition is called lactational mastitis (puerperal). Mastitis can occur less frequently in non-breastfeeding women and men. Mastitis seen in non-breastfeeding women is called non-lactational mastitis. Periductal mastitis, one of the mastitis that occurs in the non-breastfeeding breast, starts around the nipple and is 90% related to smoking. It is seen in young patients with a mean age of 35 years. It is thought that smoking causes damage to the milk ducts behind the nipple and increases the tendency towards bacteria. Another type of mastitis is idiopathic granulomatous mastitis, the cause of which is unknown and seen in patients of childbearing age, autoimmune (reaction of immune system elements against the breast tissue more than normal) mastitis. Although rare, mastitis due to diseases such as tuberculosis mastitis and fungal mastitis and sarcoidosis can be seen in the breast. Tuberculosis mastitis and other mastitis are more common in developing countries such as our country and in patients with suppressed immune system (such as AIDS, chronic kidney failure). Here we will talk about mastitis seen in postpartum lactating mothers, which we call lactational mastitis. Mastitis is seen in 3-20% of lactating mothers. It most commonly occurs within the first 6 weeks after birth. Although it can be seen at any time during lactation, its incidence begins to decrease after 3 months.

What Causes Mastitis?

The main mechanisms in the development of mastitis; milk from the breast Inadequate emptying, ponding of the milk in the udder and bacterial growth in the milk. Giving milk is something learned through experience. Inadequate breastfeeding technique and weakness in the sucking power of the newborn baby cause the milk in the breast to not be adequately emptied. In addition, although rare, this milk stasis, which can occur due to reasons such as external pressure that prevents the flow of the channels that empty the milk, creates a nutrient medium for bacteria and prepares the ground for mastitis.

• Bacterial Infection in the Breast:

Normally, there are many bacteria on the skin. Therefore, mastitis can also be caused by these bacteria on the skin on the breast, or through a crack or scratch-like opening in the nipple, bacteria can progress into the breast tissue. Wounds and cracks on the nipple; While it affects breastfeeding by causing pain, it also creates an entrance gate for the bacteria in the baby's mouth and skin flora. In addition, breast pads made of inappropriate material (plastic derivatives) used by the mother may cause irritation on the nipple, which may constitute a basis for mastitis. With the onset of mastitis, some cytokines belonging to the body's defense system against infection in the body go to the infection area and initiate the infection response. This manifests itself in the form of pain, swelling, redness and increased temperature. There are other factors that may pose a risk in the formation of mastitis. These factors are:

• Previously having mastitis
• Fissures and injuries on the nipple
• Failure to apply the right breastfeeding techniques
• Excessive fatigue and stress
• Poor nutrition
• Smoking
• Rarely, wearing a long tight bra, wearing tight clothes, wearing the seat belt over the full breast, carrying heavy items on the lap, etc. They can be listed as behaviors that may restrict milk flow.

What are the Symptoms of Mastitis?

Symptoms of mastitis may differ depending on the degree of the disease. However, mastitis symptoms usually tend to progress rapidly. Common mastitis symptoms can be listed as follows. r:

• Redness, swelling and tissue stiffness in the breast,
• Increased temperature in the breast,
• Feeling severe pain when touching the relevant breast tissue in the breast,
• A burning sensation that occurs constantly or during breastfeeding,
• Swelling in the armpit lymph nodes,

In addition to the above when the infection progresses in mastitis:

• Anxiety, being stressed
• Fever
• Shakes
• Fatigue, weakness
• Feeling low
• Symptoms such as general body pain may also occur.

Some complications may develop if mastitis is not treated. These complications are as follows:

• Recurrent Mastitis: Women who have had mastitis once have a higher risk of recurrence. Recurrence of mastitis is usually due to inadequate treatment or late initiation of treatment.
• Abscess: In untreated cases that become chronic mastitis, pus formation in the breast tissue and abscess formation may occur.
• Sepsis: Sepsis occurs as a result of the spread of infection in the breast throughout the body. Although rare, sepsis can cause serious health problems.

How is Mastitis Diagnosed?

The patient's history and examination are usually sufficient for the diagnosis of mastitis. The doctor may ask the patient what their complaints are, the situations that increase or decrease their complaints, and the breastfeeding order. In the examination; Breasts are evaluated in terms of features such as color change, temperature increase and size. It is checked whether there are areas in the breast where pain is felt by touch. If the history and examination are compatible with breast inflammation, the diagnosis of mastitis can be made. Imaging methods (ultrasonography) and interventional methods (abscess drainage with a needle, sampling) can be used for the diagnosis of mastitis and breast abscess that may occur after it.

A type of cancer called inflammatory breast cancer causes symptoms similar to mastitis in the breast. . Although inflammatory breast cancer is rare, the doctor may use imaging techniques such as breast ultrasound or mammography to confirm the diagnosis. If the mastitis symptoms in the patient do not go away despite treatment, a biopsy can be taken from the breast to rule out the risk of cancer.

Mastitis Treatment

Medication is usually sufficient in the treatment of mastitis. Used for the treatment of mastitis The drugs are as follows:

• Antibiotic: In case of infection-related mastitis, 7-10 days of antibiotic use may be necessary. The prescribed antibiotic should be used until it is completely gone. Some patients stop using antibiotics once their symptoms are relieved. However, it should be kept in mind that in this case, mastitis may recur and the problem of persistent mastitis may occur. When mastitis recurs, stronger antibiotics may be needed to eliminate the infection.
• Painkillers: Drugs such as paracetamol reduce the pain felt in the breast in mastitis.

The most important point to be considered during the treatment of mastitis is that breastfeeding should not be stopped and that it should be breastfed more frequently. Continuing to breastfeed the baby's mother regulates the flow of milk in the breast and prevents exacerbation of mastitis symptoms. In addition, it should not be forgotten that the ideal food for the baby, especially in the first 6 months, is breast milk. Cessation of breastfeeding during mastitis may lead to increased milk accumulation in the breast and the development of abscess. If abscess development is suspected in patients with mastitis, ultrasonography should be performed to check whether there is an abscess. If an abscess is found, it is necessary to drain the abscess with ultrasonography-guided drainage or surgical method. It is necessary to examine the drained fluid microbiologically, that is, to do culture and antibogram. It is wrong to think that 'the baby will be infected' by continuing to breastfeed during mastitis. Moreover, breast milk contains high amounts of anti-inflammatory. This is even protective for the baby. Sometimes mothers complain that the baby does not want to suckle the sick breast during mastitis. This is due to the change in the taste of the milk. In this case, the breast must be emptied with a pump.

Is Mastitis Gone with Home Practices? How It Goes?

Here are some things to do for women with mastitis in the breast:

• Frequently breastfeed the baby
•   It is recommended to start breastfeeding with the breast with mastitis first. Since the baby will be hungrier, the breast will be sucked stronger and thus the milk will be discharged more easily.
• If milk remains in the breast after breastfeeding, expressing the milk,
• It is also important to breastfeed the baby in different ways instead of always in the same position.
• From the top of the breast to the nipple proper massage can have a positive effect on preventing the development of mastitis, as it will facilitate the flow of milk during breastfeeding. applying compress

What to Do to Avoid Mastitis?

Breast pain and stiffness are very common in breastfeeding mothers. It is very important to apply correct breastfeeding techniques to prevent this situation from continuing and turning into mastitis.

Recommended methods for breastfeeding;

• Excessive filling of the breast with milk should be avoided, the baby should be breastfed frequently,
• Make sure that the baby grasps the nipple and head correctly and completely If necessary, the nipple should be placed in the baby's mouth by hand,
• If the milk from the breast is delayed a little, a few drops of milk should be massaged by hand before breastfeeding,
• The baby should be breastfed in different positions and all the quadrants should be empty. should be provided,
• If milk remains in the breast after breastfeeding, excess milk should be expressed,
• The nipple should be checked daily to see if there are any wounds or scratches,
• The nipple should be moisturised. It should be supported with creams,
• A warm-hot compress should be applied to the breast and massaged before breastfeeding,
• When the baby is weaned, it should be stopped gradually, not suddenly,
• Tight bras and tight clothes should not be worn, pressure should not be created on the breast,
• Daily showering and hygiene should be observed.
• Probiotic use may be recommended. Studies on the preventive effect of probiotics on mastitis development are reported.

Mastitis in pregnancy is a common health problem especially in women during breastfeeding. It is very important to diagnose mastitis in the early period and start its treatment. In this way, the mother can easily return to breastfeeding her baby. In addition, complications due to delay in mastitis treatment are prevented. Therefore, women with symptoms such as tenderness and redness in their breasts should apply to the nearest health institution without wasting time.

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