Mastitis – breast infection / bacterial and non-bacterial
Breast inflammation is usually caused by a bacterial infection. The milk duct is blocked, it usually occurs around the nipple. Mastitis due to infection is common in lactating women. Mastitis may also occur due to viral or chronic infections that are diagnosed by a doctor
For a long time, breast infections have been one of the common problems of this organ among women. In ancient Iranian medicine and other ancient medical texts of other countries, there are materials about breast infections and abscesses.
Currently, breast infection is one of the common complaints of women who refer to surgical and gynecological clinics. Diagnosing common breast infections in the acute stage is not a difficult task, and symptoms of infection and inflammation include pain, redness, fever, swelling, and sometimes palpation of the mass. The importance of uncommon breast infections in differentiating them from cancers is due to the appearance of cancer-like symptoms. For this reason, it is important to know breast infections from different aspects such as symptoms, diagnosis and treatment.
In general, breast infections can be divided into two main categories:
1- Breast infections during breastfeeding
2- Breast infections during non-lactation
Breast infections may be limited to the breast or appear following a general disease in the body.
Breast infections during breastfeeding
Breast inflammation and infection are common during breastfeeding. Of course, with the use of antibiotics during childbirth, the incidence of these infections has decreased, but still many nursing mothers suffer from this problem. Adequate attention and care of the breast during pregnancy and breastfeeding can reduce the chance of contracting these infections. These cares include proper hygiene, prevention of milk filling in the breast and prevention of nipple scratches.
During breastfeeding, it is necessary to wash the breasts before and after feeding the child. The nipple should be kept dry and clean, and it should be noted that all parts of the breast should be completely cleaned. Observing these points is very effective in preventing breast infections.
A common microbial agent in the occurrence of breast infections is a type of bacteria called “Staphylococcus aureus”. which usually enters the breast tissue through nipple scratches. The presence of milk in the breast provides a suitable food environment for the growth of microbes, and gradually, the invasion of the microbes to the surrounding parts causes the disease to spread in the breast. In the early stages of the disease, the infection is limited to a small part of the breast, but with the progress of the disease, other parts of the breast are also involved, therefore, even if possible, the occurrence of nipple scratches should be avoided. Proper breastfeeding can prevent these scratches. Also, in case of these scratches, frequent emptying of the breast and taking care of the nipple hygiene should be done to prevent breast infection.
Taking care of breast health during pregnancy and breastfeeding reduces the chances of getting breast infections during breastfeeding.
Breastfeeding mothers are susceptible to breast infection in two stages of breastfeeding:
1- During the first month of breastfeeding after the first pregnancy: At this time, due to the lack of awareness and sufficient stimulation of the mother, the nipples are more vulnerable to damage. The hygiene of the breasts is less respected and the breasts are not adequately cared for. In this way, about 75% of breast abscesses during breastfeeding occur in the first month after giving birth.
It is recommended to young mothers:
- When feeding the baby, put the areola and the nipple into the baby’s mouth. If only the nipple enters the baby’s mouth, the possibility of nipple scratches is more likely.
- Wash the nipples with warm water before and after feeding the baby.
- Always keep the nipple and the area around it clean and dry.
- Whenever your baby is hungry, give him milk. By doing this, not only your milk will increase, but due to the frequent emptying of milk, the possibility of breast infections will decrease.
2- At the time of weaning the child: During this period, due to more accumulation of milk in the breasts and also due to the presence of teeth in the child’s mouth and damage to the nipple, the possibility of infection increases.
In any case, if the disease occurs, the patient complains of redness and painful swelling of the breast, which is often accompanied by symptoms such as fever. In the initial stages, only a slight inflammation and redness can be seen in the skin, and if the treatment is not done, as the disease progresses, an abscess will form and the skin on it may become injured. In patients who have been treated with antibiotics, there may be no usual symptoms of the disease and only a palpable mass, therefore the disease can be clinically in two stages.
1- Soft tissue inflammation (cellulitis) without pus accumulation
2- Abscess
In the stage of soft tissue inflammation, there is slight redness on the skin, sensitivity to touch and pain in that area. The skin on the affected area is slightly warmer than other areas. If there is no treatment and the infection progresses, as mentioned before, a cavity containing pus is formed, which is a breast abscess. In this case, the skin symptoms are more obvious and the pain is more severe.
In the meantime, an intermediate stage may also be observed. This stage is when the patient has been treated with antibiotics and the symptoms of the acute stage of the disease have subsided, but have not completely recovered. Only one mass may be touched at this stage. At this stage, a careful examination of the breast should be performed and, if necessary, the help of diagnostic methods such as sonography should be taken, and appropriate treatment should be performed according to the patient’s condition.
The treatment will be different according to the stage of the disease and the condition of the patient:
1- Stage of soft tissue inflammation: In this stage, with antibiotic treatment, the patient’s symptoms improve rapidly. Proper treatment at this stage eliminates the possibility of abscess formation.
Conducting test and culture of secretions can open the way for changes in antimicrobial treatment. Since antibiotics are secreted in milk, it is necessary to avoid the use of drugs that cause harm to the baby, such as tetracycline, metronidazole and gentamicin. Treatment with antibiotics at this stage causes complete recovery in many patients, although 5-10% of patients develop abscess despite this treatment.
2- Disease in the abscess stage: After the formation of an abscess, which is usually 48 hours after the onset of the disease, the use of antibiotics can temporarily relieve the symptoms, but because it cannot penetrate into the cavity of the abscess, it cannot Prevent the progress of the disease. In cases where the presence of an abscess is not certain, the diagnosis can be confirmed by needle aspiration. In these cases, the use of sonography is also helpful. After diagnosing the abscess, it is necessary to perform surgery to drain the abscess.
Along with this treatment, emptying of milk from the affected breast should also be done. This work is done with the help of manual milking or by using a milk shower or sucking the baby. Breastfeeding from a healthy breast should also be continued.
Breast infections during non-lactation
Compared to the infections during breastfeeding, these infections are seen at older ages and the microbial diversity is more in them. Non-lactating infections can be divided into two categories: infections in the central part and around the areola of the breast and infections in the peripheral part of the breast.
Infections of the central part of the breast
In these patients, the infection is related to the milk ducts under the areola of the breast. These infections are seen in women who are of reproductive age (15-45 years old) and in terms of microbes, they usually contain several types of microbes at the same time. New studies have shown that smoking plays an important role in causing this type of breast infection.
The manifestation of the disease may be in the form of inflammation around the areola of the breast with or without an inflammatory mass, or in the form of an abscess. Pain in the central part of the breast, swelling of the nipple and discharge from the nipple may also be seen. Treatment includes the use of appropriate antibiotics and, if there is an abscess, draining the abscess with surgery. Abscesses associated with such infections have a greater tendency to recur.
If the inflammatory mass does not disappear after appropriate and correct treatment, the existence of a cancerous mass should be suspected, although this situation is not common.
Sometimes it is possible to establish a communication path between the skin of the breast in the area around the areola and a large milk duct under the areola, which is called a fistula. Fistula may be created after the rupture of a non-lactating abscess, after the spontaneous secretion of an inflammatory mass around the areola, or after taking a sample from an inflammatory mass around the milk duct. Treatment of fistula is to remove the part of the damaged duct and use antibiotics. Recurrence after surgery is common, and the lowest rate of recurrence and the best results in terms of beauty are obtained in specialized breast centers.
Infections and abscesses of the peripheral part of the breast
These abscesses are less common than the previous type and are usually seen at older ages. In postmenopausal women, peripheral breast abscesses often appear suddenly without any underlying disease. The cause of their occurrence is not known, and in the conducted studies, the expansion of breast ducts in menopause age has been found to be effective in its occurrence. Their treatment is surgical drainage of pus. Also, peripheral breast abscesses are seen in people suffering from underlying diseases such as diabetes, corticosteroid drugs, and trauma. These abscesses are also cured by surgical drainage. Recurrence is common in these abscesses, and sometimes there is a need for frequent drainage of pus. Also, if the symptoms do not improve with antibiotic treatment, it should be thought of malignancy. Sampling of the abscess wall is necessary to rule out malignancy.
Breast infection in immunocompromised people
These infections are usually seen in people who use drugs that weaken the immune system or in patients with acquired immune deficiency (AIDS). The occurrence of breast abscess is common and the microbial diversity is also more in these cases.
Tuberculosis is also a cause of breast abscess in these patients and may be one of the first manifestations. Therefore, the presence of an abscess outside of breastfeeding requires careful examination of the patient. In patients with AIDS, breast abscess develops rapidly and in some cases it can lead to the death of the patient.
Abscesses following breast cancer surgery and radiotherapy
From the point of view of treatment, this type of abscess occurs on average about 5 months after the treatment. The cause of these abscesses can be a large empty space at the sampling site, the presence of breast infection before sampling, and fluid accumulation at the operation site (seroma). The treatment of these types of abscesses is the administration of antibiotics along with the drainage of pus.
Breast abscess in infancy
These types of abscesses are formed during infancy and in 20% of cases, the patient recovers with the use of antibiotics. In other cases, they find the need for a pus drainage using a needle or surgery and then antibiotic treatment, and recurrence after treatment has not been seen. The important point in the treatment of patients is that in the event of an abscess during infancy, adequate care is necessary in terms of preventing damage to the breast tissue, because the destruction of the breast tissue caused by inflammation and infection, as well as the drainage of pus through surgery, can affect the growth of the breasts in the future. The patient creates a problem.
Fungal infections of the breast
Some fungi can cause infection in the breast. A common clinical symptom is a lump in the breast that can be mistaken for cancer. Proper treatment with antifungal drugs is very effective in many cases. In some cases, surgical intervention is needed. In some nursing mothers who suffer from nipple pain, it can be caused by fungi.
In women with large and hanging breasts, there is a fungal infection in the lower parts of the breast, which can be treated with proper hygiene and medical treatment.
Viral infections of the breast
Breast inflammation has also been seen following viral diseases such as erion, which occurs as a painful swelling of the breast, and the patient’s symptoms subside with the recovery of the viral disease.
Summary
Taking care of breast hygiene during breastfeeding and avoiding scratching the nipples reduces the chance of getting breast infections during breastfeeding.
Symptoms of infection include redness, warmth, pain, and sometimes swelling.
If not treated, an abscess will develop, the treatment of which is to drain the pus surgically.
Non-lactating breast infections are often seen at older ages, and in them, the possibility of underlying diseases such as diabetes and breast cancer, the use of corticosteroids, and trauma should be taken into account.
● Presence of abscess and inflammation is not a common symptom of breast cancer.
It is recommended to young mothers:
1- When feeding the baby, put the areola and the nipple into the baby’s mouth. If only the nipple enters the baby’s mouth, the possibility of nipple scratches is more likely.
2- Wash the nipples with warm water before and after feeding the baby.
3- Always keep the nipple and the area around it clean and dry.
4- Whenever your baby is hungry, give him milk. By doing this, not only your milk will increase, but due to the frequent emptying of milk, the possibility of breast infections will decrease.
Source – Dr. Ahmad Kaviani