Mastitis (Breast Infection) in Breastfeeding, Non-Lactating Women

The female breast develops after puberty to cater for the production and delivery of milk to offspring after childbirth. Fat tissue within the breast, apart from providing protection, is also a rich supply of energy for this purpose. The breast has numerous alveoli which empty its secretion into ductules that drain into the lactiferous ducts. The milk accumulates at the lactiferous sinuses before being passed out into the exterior through the nipple. Although breastfeeding is a rewarding bonding experience between mother and child, apart from physically nourishing the infant, it may predispose the mother to certain injuries and infections that would not normally arise.

Mastitis is the term for infection of the breasts and while acute cases are more common in breastfeeding women, it can also arise in non-lactating women particularly when there is a structural defect of the breast or chronic systemic disease. The possibility of developing an infection should not detract mothers from breastfeeding but immediate medical attention should be sought once the symptoms start to develop. Breastfeeding mothers will not definitely develop mastitis and a little caution may help in preventing an infection.

Causes of Mastitis in Women

Breast infections in lactating women (lactational mastitis) typically arises in the first 6 weeks of breastfeeding. The nipple is generally sore and develops small cracks and fissures which allow bacteria to invade the underlying tissue.  These infections are more central (from the nipple), superficial and may lead to the formation of abscesses. This may be just a single abscess or multiple abscesses. The bacteria involves in these infections are typically found on the skin of humans. It includes Staphylococcus aureus, Streptococcus epidermidis and other streptococci. Although the infection is superficially initially, it may spread to deeper layers without appropriate treatment as early as possible. An entire lactiferous duct and its ductules as well as the lobules may be involved. Frequent drainage of milk may play an integral role in ‘washing’ away the bacteria and preventing deeper infection.

Non-lactational infections may be associated with other causes like injury to the breasts, postoperative infection and in immunocompromised patients like those with HIV or uncontrolled diabetes mellitus. The infection is more likely to affect the periphery of the breast and is usually chronic in nature. Another types of chronic mastitis is perilobular mastitis where keratin plugs arise within the ducts and block it. A secondary infection then sets in. It is more often associated with nipple deformities.

Signs and Symptoms of Mastitis

Mastitis, as with any inflammation, presents with tenderness or pain of the breasts, swelling and redness. The skin over the infected area may feel warmer than normal. An abscess may be seen as obvious bump on the breast surface with redness of the skin over the abscess and warmth. Initially an infection may present as just mild discomfort but quickly progresses to more acute symptoms if there is no intervention. A discharge from the breast may be present and this is often yellow to green with a foul odor. Other features may include a fever, fatigue and headaches.

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