What is Mastitis?

Mastitis is an infection of the tissue of the breast that occurs most frequently
during the time of breastfeeding. This infection causes pain, swelling, redness, and
increased temperature of the breast. It can occur when bacteria, often from the baby's
mouth, enter a milk duct through a crack in the nipple. This causes an infection and
painful inflammation of the breast.

Breast infections most commonly occur one to three months after the delivery
of a baby, but they can occur in women who have not recently delivered as well as in
women after menopause. Other causes of infection include chronic mastitis and a rare
form of cancer called inflammatory carcinoma.

Complications that may arise from mastitis

include:
• Recurrence. Once you've had mastitis, you're more likely to get it again,
either breast-feeding the same infant or a future child. Delayed or inadequate
treatment is usually to blame for mastitis recurrence.
• Milk stasis. When the milk isn't completely drained from your breast during
breast-feeding, milk stasis can occur. This causes increased pressure on the
ducts and leakage of milk into surrounding breast tissue, which can lead to
pain and inflammation.
• Abscess. When mastitis is inadequately treated, or if it's related to milk stasis,
a collection of pus (abscess) can develop in your breast. An abscess usually
requires surgical drainage. To avoid this complication, talk to your doctor as
soon as you develop signs or symptoms of mastitis.

Etiology
Mastitis may occur with or without infection. Infectious mastitis and breast abscess
are usually caused by bacteria colonizing the skin. The vast majority are due to
Staphylococcus aureus, followed by coagulase-negative staphylococci. The majority
of S. aureus isolates are now resistant to methicillin.
Noninfectious mastitis may result from underlying duct ectasia (periductal mastitis or
plasma cell mastitis) and infrequently foreign material (e.g., nipple piercing, breast
implant, or silicone). Granulomatous (lobular) mastitis is a benign disease of
unknown etiology.

Types of Mastitis

• Lactational mastitis: breast inflammation with or without infection associated

with breastfeeding.
• Nonlactational mastitis: breast inflammation associated with or without
infection in the nonlactating breast.
• Noninfectious mastitis: breast inflammation due to a noninfectious and/or
idiopathic etiology.
• Subclinical mastitis: refers to the finding of a raised sodium/potassium ratio
• and interleukin in milk without clinical mastitis.
• Breast abscess: localized breast infection with a walled-off collection of pus.

• Area of the breast (other than the nipple) that is tender to the touch
• Sore area of the breast is hard, warm, and/or red and splotchy
• Flu-like symptoms; feeling exhausted and wiped out
• Fever of 101 F (38.3 C) or higher

Signs and Symptoms

 Area of the breast (other than the nipple) that is tender to the touch
 Sore area of the breast is hard, warm, and/or red and splotchy
 Flu-like symptoms; feeling exhausted and wiped out
 Fever of 38.3 C or higher
 Body aches
 Fatigue
 Breast engorgement
 Rigor or shaking
Indications that this more serious infection has
occurred include the following:

o Tender lump in the breast that does not get smaller after breastfeeding
a newborn (If the abscess is deep in the breast, you may not be able to
feel it). The mass may be moveable and/or compressible.

o Pus draining from the nipple

o Persistent fever and no improvement of symptoms within 48-72 hours

of treatment

Nursing Interventions: Mastitis

1. Give analgesics as indicated.

2. Provide comfort measures such as a warm soaks.
3. Use meticulous hand-washing technique and provide good skin care.
4. Regularly measure the patient’s temperature and assess the effectiveness of
antipyretic agents.
5. Inspect the patient’s breast daily for signs of impaired skin integrity, such as
cracks and fissures.
6. Advise the patient to take antibiotics as ordered.
7. Stress the need to take the entire prescribed amount even if symptoms improve
in the meantime.
8. Reassure the patient that breast-feeding during mastitis won’t harm her infant
because the infant is the source of the infection.
9. If only one breast is affected, instruct the patient to offer the infant his breast
first to promote complete emptying and prevent clogged ducts.
10. Suggest applying a warm, wet towel to the affected breast or taking a warm
shower to relax and improve her ability to breast-fed.

Treatment

• Antistaphylococcal antibiotics

Treatment includes encouragement of fluid intake and antibiotics aimed at

Staphylococcus aureus, the most common causative pathogen. Examples are
dicloxacillin Some Trade Names
DYCILL
DYNAPEN
PATHOCIL
Click for Drug Monograph
500 mg po q 6 h for 7 to 10 days and, for women allergic to penicillin, erythromycin
Some Trade Names
ERY-TAB
ERYTHROCIN
Click for Drug Monograph
250 mg po q 6 h. If women do not improve and do not have an abscess, vancomycin
Some Trade Names
VANCOCIN
Click for Drug Monograph
1 g IV q 12 h or cefotetan Some Trade Names
CEFOTAN
Click for Drug Monograph
1 to 2 g IV q 12 h to cover resistant organisms should be considered. Breastfeeding
should be continued during treatment because treatment includes emptying the
affected breast.