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Mastitis & Breast Engorgement - Causes, Sign & Symptoms & Treatment

Mastitis (parenchymatous inflammation of the mammary glands) & breast engorgement (congestion) are disorders that may affect lactating females. Mastitis occurs postpartum in about 1%, mainly in primiparas who are breast­feeding. It occurs occasionally in non­lactating females & rarely in males. All breast-feeding mothers develop some degree of engorgement, but it's especially likely to be severe in primiparas. The prognosis for both disorders is good.

reason of mastitis & breast engorgement

Mastitis develops when a pathogen that typically originates in the nursing infant's nose or pharynx invades breast tissue through a fissured or cracked nippie & disrupts normal lactation. The most common pathogen of this type is Staphylococcus aureus; less frequently, it's Staphylococcus epidermidis or beta hemolytic streptococci. Rarely, mastitis may result from disseminated tuberculosis or the mumps virus. Predisposing factors include a fissure or abrasion on the nipple; blocked milk ducts; & an incomplete let down reflex, usually due to emotional trauma. Blocked milk ducts can result from a tight bra or prolonged intervals between breast-feedings.

Signs & symptoms of mastitis & breast engorgement

Mastitis may develop anytime during lactation but usually begins 3 to 4 weeks postpartum with fever (101° F [38.3° C] or higher in acute mastitis), malaise, & flu like symptoms. The breasts (or, occasionally, one breast) become tender, hard, swollen, & warm. Unless mastitis is treated adequately, it may progress to breast abscess.

Diagnosis of mastitis & breast engorgement

In a lactating female with breast discomfort or other signs of inflammation, cultures of expressed milk confirm generalized mastitis; cultures of breast skin surface confirm localized mastitis. Such cultures also determine the appropriate antibiotic treatment. Obvious swelling of lactating breasts confirms engorgement.

Treatment of mastitis & breast engorgement

Antibiotic therapy, the primary treatment for mastitis, generally consists of penicillin G to combat staphylococcus; erythromycin or kanamycin is used for penicillin-resistant strains. Although symptoms usually subside 2 to 3 days after treatment begins, antibiotic therapy should continue for 10 days. Other appropriate measures include analgesics for pain and, rarely, when antibiotics fail to control the infection & mastitis progresses to breast abscess, incision & drainage of the abscess.

The goal of treatment of breast engorgement is to relieve discomfort & control swelling, & may include analgesics to alleviate pain, & ice packs & an uplift support bra to minimize edema. Rarely, oxytocin nasal spray may be necessary to release milk from the alveoli into the ducts. To facilitate breast-feeding, the mother may manually express excess milk before a feeding so the infant can grasp the nipple properly.

Special considerations If the patient has mastitis:

• Isolate the patient & her infant to prevent the spread of infection to other nursing mothers. Explain mastitis to the patient & why isolation is necessary. . Obtain a complete patient history, including a drug history, especially allergy to penicillin.
• Assess & record the cause & amount of discomfort. Give analgesics, as needed.
• Reassure the mother that breast-feeding during mastitis won't useful less her infant because he's the source of the infection. Tell her to offer the infant the affected breast first to promote complete emptying of the breast & prevent clogged ducts. However, if an open abscess develops, tell her to stop breast­feeding with this breast & use a breast pump until the abscess heals. She should continue to breast-feed on the unaffected side.

CLINICAL TIP Suggest applying a warm, wet towel to the affected breast or taking a warm shower to help her relax & improve her ability to breast-feed.

• To prevent mastitis & relieve its symptoms, teach the patient good health care, breast care, & breast-feeding habits. Advise her to always wash her hands before touching her breasts.
• Instruct the patient to combat fever by getting plenty of rest, drinking sufficient fluids, & following prescribed antibiotic therapy.
  If the patient has breast engorgement:
• Assess & record the level of discomfort. Give analgesics, & apply ice packs as needed.
• Teach the patient how to express excess breast milk manually. She should do this just before nursing to enable the infant to get the swollen areola into his mouth. Caution against excessive expression of milk between feedings because this stimulates milk production & prolongs engorgement.
• Explain that because breast engorgement is caused by the physiologic processes of lactation, breast-feeding is the best remedy. Suggest breast-feeding every 2 to 3 hours & at least once during the night.
• Ensure that the mother wears a well­fitted nursing bra that isn't too tight.

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