Mastitis

Mastitis is a condition in which an abnormal swelling or inflammation occurs in a woman's breast tissue. Usually caused due to an infection in the breast ducts. Breastfeeding mothers are the ones most suffering from this condition.

Mastitis can occur due to the presence or absence of infection. As the condition progresses, it can result in an abscess or (swelling) of the breast. Another significant characteristic of this condition is an accumulation of pus within the breast tissue. Mastitis can be fatal in certain cases if left untreated.[1]

What are the causes of Mastitis?

The infection is caused due to clogged milk ducts which do not allow the milk to come out. This results in the body’s defense mechanism ie the [WBCs]white blood cells release substances to fight the disorder, this in turn can lead to increased blood flow and swelling. The part of the breast which is infected may become painful, swollen, warm, and red when touched. Mastitis can also result in symptoms like headache, fever, and symptoms that resemble flu [2].

This can be caused by conditions when :

The infant does not attach itself properly to the breast.
The infant has difficulty sucking the milk from the breasts.
The infant breastfeeds in an infrequent manner.

The milk ducts might get blocked due to pressure on the breast which might be caused due to the above conditions or because of wearing tight clothing. It is noticed often that the mothers place a finger in order to move the breast out of the way so that it does not indulge with the baby’s nose. As the finger is placed on the same spot every day, this becomes a plugged duct later on.

Any obstruction that interferes with the pathway of milk not allowing it to be expressed properly will result in milk getting built up in the breast or milk stasis, leading to blockages in milk ducts. Due to the blockages in the milk ducts, stagnation of milk occurs which becomes the breeding ground for bacteria leading to the infection. This bacterial species generally does not grow in fresh human milk. Another possibility is that the bacteria present on the skin surface may enter through small cracks or breaks in the skin of the breast. [3]

How common is mastitis?

Mastitis is most common in the first three months of breastfeeding. It affects around 10% of the breastfeeding population in the U S. And around 30% of the breastfeeding population worldwide.

The risk of mastitis increases if nipple piercing is done by an unregistered or non-professional practitioner.

Can Mastitis occur in the case of the non-breast-feeding category of females?

Women who are not breast-feeding or in other words not producing milk may also develop mastitis. Although this is not common in this case and this condition is known as periductal mastitis. Non-lactating mastitis, infectious in nature occurs in females who are regular smokers and are of age criteria 20 - 30 years(3)

Can mastitis occur in males?

Granulomatous mastitis or Plasma cell mastitis is a inflammatory disorder of the breast parenchyma which is chronic in nature occurring on rare occasions and etiology or cause of the disorder is unknown (8)

Symptoms:

Women suffering from mastitis may feel unwell. In addition to an inflamed breast, they may suffer from other symptoms which may include:

Pain in the breast
Swelling in breast
The breast has a warm sensation when touched
A red, tender, wedge-shaped area is visible on the breast
Nipple discharge
A burning or pain sensation causing discomfort while breastfeeding
Raised temperature
Vomiting
Nausea
Chills
Only one breast at a time is affected by mastitis at a time

Diagnosis:

A thorough physical exam will be done by the doctor and the patient will be asked about their symptoms. A culture of breast milk will help the doctor to prescribe a suitable antibiotic for the particular person especially if they have an infection that is severe in nature.

Inflammatory breast cancer also causes similar symptoms to mastitis like for example swelling or redness therefore it can be initially confused with mastitis. The doctor may recommend

A mammogram
Ultrasound or both for diagnostic purposes

If the symptoms are observed even after the course of antibiotics is completed, the person may need a biopsy to make sure she doesn't have breast cancer.

Treatment:

The treatment for mastitis involves:

Antibiotics: For the person suffering from mastitis,a 10-day course of antibiotics is administered. Taking the dose of medication accurately and on time is important to minimize the chance of recurrence of the condition. If mastitis doesn't get cured even after taking antibiotics, consult your doctor accordingly.
Pain relievers: Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) may be suggested by the doctor.

Drugs and mechanism of action:

Beta-lactamase-resistant penicillins have been prescribed in the treatment of mastitis. These drugs include dicloxacillin, flucloxacillin, or cloxacillin. Due to the acidic nature of penicillin, their concentration is poor in human milk, as the milk also has an acidic nature. Cloxacillin is used for the treatment of bacterial infection also known as (cellulitis). Erythromycin, on the other hand, is alkaline in nature, therefore it is active in human milk. Although there are some strains of staphylococci (rare in nature) which are resistant towards erythromycin, This drug may be regarded as the best antibiotic in the treatment of breast adenitis, a condition in which the infection occurs in the milk ducts. Cloxacillin and erythromycin can safely be administered to infants, but in comparison erythromycin has less chances to trigger (antibiotic-sensitivity reactions). Avoid TMP-SMX in case of women who are breastfeeding infants less than 1-month-old, or the infant is premature.(9)

NOTE: Always seek the advice of your doctor or other qualified health provider regarding a medical condition.

Home Remedies:

Home remedies for inflammatory mastitis are as follows:

Ice: Use an ice pack to reduce swelling by applying it around the area affected, while sleeping on the back. Avoid application of heat.
Pain relievers: Using anti-inflammatory drugs nonsteroidal in nature like ibuprofen can reduce pain experienced.
Lymphatic drainage: Involves application of light,gentle pressure on the breast toward the lymph nodes above the collar bones. It causes reduction in swelling due to movement of fluid.
Reverse pressure softening (RPS): This type of massage allows the baby to latch more easily. In order to perform RPS, place the tip of two fingers around the base of the nipple. Apply slight pressure and drag the fingers away from the area. Perform this at several different angles around the nipple. This technique is very effective in nature.
Wear a supportive bra- wearing a bra which is comfortable and not too tight. [6]

Complications:

The following can be the complications in the case of mastitis:

Recurrence of mastitis (may occur if treatment is delayed)
Milk builds up in breast or milk status
Pus accumulation in the breast (breast abscess) regarded as the most severe complication for women
Early termination of breastfeeding.
Fistula formation (only responds to surgical fistulectomy)
Breast tissue deformity. (10)

Prevention:

A talk with a lactation consultant will be advisable. Another suggestion can be attending breastfeeding classes to learn what a good latch feels like. A good latch helps with mastitis because the body adjusts the milk production as per the milk intake of the baby in a natural mechanism.

Mastitis from the point of view of Ayurveda

Sthanavidhradi is another name for mastitis in the context of Ayurveda, this disease is in relation to Pitta dosha. Ayurveda treats mastitis by stabilizing the Pitta and Kapha dosha in the body.[7]

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