RESPONSI

MASTITIS

Lecturer:
Dr. dr. Bambang Arianto, Sp.B

By:
Brilliant Tantomo
2017.04.2.0087
Literature
 Introduction -
Background
• Occurrence : 10 percent of U.S. mothers who are
breastfeeding.
• Clinical diagnosis : focal tenderness, fever, malasie.
• Treatment : changing breastfeeding technique,
antibiotics, analgesics.
• Common complication : breast abscess  surgical
drainage / needle aspiration.
 Definition
• Tender, hot, swollen, wedge-shaped area of breast
associated with temperature of 38.5°C / greater,
chills, flu-like aching, and systemic illness.
• An inflammation of the breast; may or may not
involve a bacterial infection.
 Epidemiology
• Developing in 5– 33% of women during lactation
(usually in the early stages)
• May be unilateral or bilateral.
• Staphylococcus aureus by far acts as an etiological
agent.

Etiology
• S. aureus  most commonly implicated organism
which gains entry via cracked nipple.
• Milk provides an ideal culture medium.
 Risk Factors
• Cleft lip or palate • Use of a manual breast pump
• Cracked nipples • Yeast infection
• Infant attachment difficulties
• Local milk stasis
• Missed feeding
• Nipple piercing
• Plastic-backed breast pads
• Poor maternal nutrition
• Previous mastitis
• Primiparty
• Restriction from a tight bra
• Short frenulum in infant Infant with a short frenulum that, while
breastfeeding, caused nipple damage in the
• Sore nipples mother, resulting in repeated episodes of mastitis.
Classification of Mastitis
 Pathophysiology
• Each breast contains appox. 15 – 25 glandular units
(breast lobules)
• Each lobule is composed of a tubuloalveolar gland
and adipose tissue, and drains into the lactiferous
duct  empties onto the surface of the nipple.
• Below the nipple surface, lactiferous ducts form
large dilations called lactiferous sinuses, which act
as milk reservoirs during lactation.
• When the lactiferous duct lining undergoes
epidermalization, keratin production may cause
plugging of the duct, resulting in abscess formation.
• Lactating mastitis  caused by bacterial invasion
through in irritated / fissured nipple / skin abrasion.
• Non-lactating mastitis 
o Periareolar (periductal mastitis) :
• Consist of active inflammation around
nondilated subareolar breast ducts.
o Peripheral :
• Often associated with an underlying
condition, such as diabetes, RA, steroid
treatment, granulomatous lobular mastitis,
trauma, and smoking.
 Sign and Symptom
• Well-defined fluctuant lump in the affected breast
• Pain in the affected breast
• Redness, swelling, and tenderness in an area of the
breast
• Fever and malaise
• Enlarged axillary lymph nodes
 Diagnosis
• Usually made clinically
o Localized, unilateral breast tenderness and
erythema
o Fever
o Malaise
o Fatigue
o Body aches
o Headache
• Culture (recommended when the infection is
severe)
• USG
Mammography
 Management
• Effective milk removal

• Supportive measure
o Rest
o Adequate fluid & nutrition
o Application of heat  shower / a hot pack to the
breast
• Pharmacologic management
o Analgesia
o Antibiotics
 Complication
• Early cessation of breastfeeding
o Mastitis may produce overwhelming acute symptoms
that prompt women to consider cessation of
breastfeeding
o Acute cessation of breastfeeding may actually
exacerbate the mastitis and increase the risk of
abscess formation
• Abscess
o An abscess should be suspected if a well-defined
area of the breast remains hard, red, and tender
despite appropriate management.
• Candida infection
o Has been associated with burning nipple pain or
radiating breast pain symptoms
 Prognosis
• When treated promptly and appropriately, most
breast infections including abscess will resolve
without serious complications. Most patients will
have resolution of mastitis after 7 to 10 days of
appropriate antibiotic therapy.
 Prevention
• Effective management of breast fullness and
engorgement
• Prompt attention to any signs of milk stasis
• Prompt attention to other difficulties with
breastfeeding
• Rest
• Good hygiene
Case Report
 Identitas pasien
• Nama : Nn. NL
• Umur : 24 tahun
• Jenis kelamin : Perempuan
• Agama : Islam
• Alamat : Surabaya
• Tanggal Pemeriksaan : 6 Desember 2018
 Anamnesa
• Keluhan utama
o Nyeri dan bengkak pada payudara kiri
• Keluhan tambahan
o Terasa panas di payudara kiri,
 Riwayat Penyakit
Sekarang
• Penderita datang ke Poli Bedah Umum RSU Haji
Surabaya dengan keluhan bengkak dan nyeri
pada payudara kiri sejak 1 minggu yang lalu.
Payudara kiri teraba hangat dan nyeri pada
perabaan; serta terasa nyeri saat menyusui.
Keluhan demam disangkal. 1,5 tahun yang lalu
pasien melahirkan anak pertamanya dan
memberikan ASI. Pasien menyusui, namun hanya
sekitar 6 bulan. Pasien berhenti menyusui sejak 1
tahun yang lalu.
 Riwayat Penyakit Dahulu
• -

Riwayat Penyakit
Keluarga
• -
 Anamnesa Makanan &
Minuman
• Sumber makanan dan minuman berasal dari nasi,
ikan/daging, sayur, buah dan air putih
 Pemeriksaan Fisik
• Status Generalis
o Keadaan Umum : Tampak sakit sedang
o Kesadaran : Compos mentis (GCS 4-5-6)
o Status Gizi : TB : 155 cm BB : 65 kg
BMI: 27
o Vital Sign : TD : 120/80 mmHg
Nadi : 80 x/menit
Suhu : 36,6oC (axiller)
RR : 20 x/menit
oA/I/C/D : –/–/–/–
• Kepala
o Konjungtiva anemia (-)
o Sklera ikterus (-)
• Leher
o Pembesaran KGB dan Tiroid (-)
• Thorax
Pulmo : I : Normochest, gerak nafas simetris
P : Gerak nafas simetris, fremitus raba simetris
P : Sonor seluruh lapangan paru
A : Suara nafas dasar vesikuler, ronkhi –/–,
wheezing – /–
Cor :I : Ictus cordis tak tampak
P : Ictus cordis teraba 2 jari pada MCL sinistra
ICS V, tidak kuat angkat
P : Batas jantung normal
A : S1 S2 tunggal, murmur (–), gallop (–)
• Abdomen : I : Cembung simetris
P : Bising usus (+) normal
P : Soepel; H/L/R tak teraba, nyeri
tekan (-)
P : Timpani
• Ekstremitas
o Akral hangat (+)
o Edema (-)
 Status Lokalis
• Regio Mammae Sinistra
o Inspeksi : Tampak pembengkakan pada
mammae sinistra, pus (-), darah (-)
o Palpasi : Teraba hangat dan nyeri
o Movement : -
 Pemeriksaan Penunjang
• Darah Lengkap
o Hb 10,4 g/dl
o Leukosit 14,429 /mm3
o Trombosit 512,000 /mm3
o HCT 33,3 %

• Foto Thorax
• USG Mammae
USG Mammae kanan dan kiri:
o Parenchym mammae homogen, fibroglandular type
o Tampak gambaran pemadatan heterogen, batas tegas,
vascular intra lesi (-) , ukuran 18x54 mm di retroareolar kiri
o Tidak didapatkan pembesaran KGB di kedua axilla
o Kesimpulan : Gambaran proses radang retro areolar
mammae kiri
Mammography
• Mamma kanan:
o Parencym mammae firbo glandular type
o Tidak didapatkan bentukan massa /
kalsifikasi spiculate sign / penebalan kulit
o Retraksi papila mammae (-)
o Tidak didapatkan nodule di daerah axilla

• Mamma kiri:
o Parencym mamma firbro glandular type
o Didapatkan bentukan perselubungan
homogen di retroareolar, batas tegas,
tepi tak rata, masih terlihat gambaran
pattern parencyhm.
o Retraksi papilla mammae (-)
o Tidak didapatkan nodule di daerah
axilla.

• Kesimpulan : Susp massa

infiltrat retro areolar kiri
 Resume
• Perempuan, 24 tahun. Memiliki keluhan bengkak
dan nyeri pada payudara kiri sejak 1 minggu yang
lalu. Payudara kiri teraba hangat dan nyeri pada
perabaan; serta terasa nyeri ketika menyusui.
Keluhan demam disangkal. 1,5 tahun yang lalu
pasien melahirkan anak pertamanya dan
memberikan ASI. Pasien menyusui, namun hanya
sekitar 6 bulan. Pasien berhenti menyusui sejak 1
tahun yang lalu.
• Pemeriksaan fisik
o Status lokalis :
Regio Mammae Sinistra
o Inspeksi : Tampak pembengkakan pada
mammae sinistra, pus (-), darah (-)
o Palpasi : Teraba hangat dan nyeri
o Movement : -
 Diagnosa
• Mastitis Abses Mammae Sinistra
 Diagnosa Banding
• Galactocele
• Firbocystic breast
• Carcinoma mammae
 Diagnosa
• Planning Diagnosa : (-)
• Planning Terapi :
o Non Medikametosa
• Kompres hangat
• Makan-minum cukup
• Istirahat
o Medikamentosa
• Analgesik: santagesic inj 2x1 g
• Antibiotik: cefixim 2x2 g
o Tindakan
• Operatif : pro insisi drainase abses
• Planning Monitoring
o Vital sign
o Tanda-tanda komplikasi
• Planing Edukasi
o Minum obat teratur
o Kontrol sesuai jadwal
o Segera ke RS bila timbul demam, muntah, rasa
panas, atau bengkak dan nyeri muncil kembali
pada payudara
 Laporan Operasi
• Diagnosa pre operasi : Mastitis abses mammae S
• Diagnosa post operasi: Abses mammae S
• Jenis operasi : insisi drainase
• Nama dokter operator : dr. Koernia, Sp.B
• Jaringan yang di insisi : mammae
• Tanggal operasi : 7 Desember 2018
• Jam operasi : 10.40 WIB
• Lama operasi : 30 menit
• Laporan operasi :
o Informed consent + inform to consent
o AB profilaksis Cefixim 2 gr
o Insisi supra abses
o Didapatkan massa padat, berbentuk rongga dengan
dinding tebal, berisi pus 100 cc  Kultur (+)
o Dilakukan :
• Insisi drainase abses
• Bilas dengan PZ + Betadin
• Pasang drain
• Jumlah perdarahan : minimal
• Komplikasi : tidak ada
 Prognosa
• Baik
 Conclusion
• Mastitis is a disease with high economic, social, and
public health impact. In humans, the number of
women voluntarily opting for breastfeeding is
increasing in the developed world; furthermore in
developing countries, maternal breast milk is the
best (and usually only) nutritional option for children
under 1 year of age. Unfortunately, puerperal
mastitis frequently results in early weaning, depriving
many children from the benefits of breastfeeding.
Thank You