The breast consists of several ducts and glands that lead to the nipple, which is surrounded by a dark-colored area called an areola. Located below the areola are the lactiferous ducts or milk-carrying ducts extending from the nipple to the underlying breast tissue. These ducts get filled with milk after a baby is born. Mammary glands (glands that produce milk) are connected by these lactiferous ducts to the surface of the breast. Sometimes, the milk may not get fully emptied and can get clogged in the duct, which can result in an infection.
What Are Breast Infections?
Breast infections are commonly seen in lactating mothers, which take place in the fatty tissue of the breast, resulting in swelling. It is the inflammation of the breast tissues that can lead to infection and is also known as lactation mastitis. Breast infections are mainly caused by microorganisms such as Staphylococcus aureus (staph infection). Other causative microorganisms include Streptococcus pyogenes, Streptococcus agalactiae, Escherichia coli, etc. Mastitis is seen in around 2 to 30 percent of lactating mothers and is common during the first six weeks of breastfeeding but can occur anytime during lactation. However, mastitis can also occur in females who are not nursing but is relatively uncommon.
What Are the Causes of Breast Infections During Lactation?
The causes of breast infections include;
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The bacteria enters from the mouth of the infant or the mother’s skin and infects the breast through a crack, or a break in the skin, on the nipple.
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Inadequate drainage of the milk causes stagnation, leading to bacterial growth.
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Oversupply or increased production of milk.
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Rapid weaning (stopping breastfeeding and introducing other types of milk).
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Poor health or illness of the child or the mother.
What Are the Signs and Symptoms of Breast Infection?
Signs and symptoms of breast infection include:
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Breast pain or burning sensation during breastfeeding.
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Itching.
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Inflammation or enlargement of the breast.
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Fever.
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Pus discharge from the nipple.
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Redness of the skin.
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Tender and warm on touch.
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Enlarged and tender lymph nodes in the armpit of the affected side.
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Nausea and vomiting.
What Are the Risk Factors for Breast Infections During Lactation?
Risk factors for breast infections include;
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Presence of cracks or fissures in the nipple.
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Inadequate milk drainage or infrequent feeding.
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Poor latching techniques.
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Sudden cessation of breastfeeding.
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Poor hygiene.
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Prior history of mastitis.
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Use of tight-fitting bras.
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Maternal stress and lack of sleep.
Complications of Breast Infection
If breast infections are left untreated, it can lead to an abscess formation. It may be seen usually in the first pregnancy, at a maternal age of above 30 years, or a pregnancy term of more than 41 weeks. The stagnation of milk in an engorged segment may spread quickly to another segment through the milk ducts and appear as a fluctuant mass, well-circumscribed, although not always palpable if it is located deep in the breast tissue. The abscess can be extremely painful, associated with persistent fever and pus discharge, and may require surgical drainage.
How Are Breast Infections Diagnosed?
The diagnosis of breast infection is based on the history and clinical findings. A healthcare provider performs a physical examination to rule out an abscess and reviews the symptoms. In case of recurrence of infections, the breast milk can be sent to a laboratory to determine the bacterial culture and sensitivity, which facilitates treatment planning. An ultrasound may be recommended if an abscess is suspected. In the case of systemic infections, a complete blood count and blood culture are recommended. The neonate is also examined with regard to the oral cavity, skin, and nappy area. Hospital admission may be required along with the infant, in case of fever, chills, and tachycardia (increased heart rate), or if the lactating mother is unstable or immunocompromised.
How Are Breast Infections Managed?
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Patients are provided with supportive care by a warm compress along with an effective removal of the milk from the affected breast. The milk must be emptied to decrease the duration of symptoms; it may be with or without antibiotic therapy.
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Analgesics such as non-steroidal anti-inflammatory drugs such as Acetaminophen, Ibuprofen, etc. may be prescribed to reduce the pain.
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Cold packs can be applied to the affected breast, which helps to reduce the pain and swelling.
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If the symptoms are mild and the culture is negative, no treatment may be required.
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In case of severe symptoms, prolonged infections beyond 12 to 24 hours, or signs of systemic disease, antibiotics are advised based on the culture and sensitivity reports.
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If the patient is not allergic to Penicillin group of drugs, drugs such as Flucloxacillin, can be recommended. Erythromycin or Clarithromycin can be advised if the patient is allergic to Penicillin.
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A non-beta lactam antibiotic such as Amoxicillin with Clavulanic acid, or Clindamycin is recommended if MRSA (methicillin-resistant Staphylococcus aureus) is confirmed by bacterial culture reports.
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If the infection does not subside or no improvement is seen, the patient must be reassessed, and intravenous injection of Vancomycin or other antibiotics may be initiated.
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Antifungal therapy may be indicated in the case of nipple candidiasis.
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Breast abscesses usually do not resolve only with antibiotic therapy but require surgical drainage, and antibiotic therapy for seven to ten days.
Is It Safe to Lactate During Breast Infection?
It is safe to continue breastfeeding during the infection, as weaning suddenly may worsen the symptoms and can even lead to progression of the infection. The patient is encouraged to breastfeed, or pump the milk or express the milk with hands to prevent further stagnation of milk. Breast milk is known to have antibacterial properties and help the infant fight infections. Breastfeeding must be done from the affected side first, as the infant would be hungry and sucks more milk. Varying breastfeeding positions may help reduce pain and discomfort during infection. Antibiotics that are recommended for the infection are usually safe for the babies, and hence, breastfeeding should be continued throughout the treatment.
How Can Breast Infections Be Prevented?
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Patients must be educated to breastfeed the infant frequently to prevent stasis of milk, which prevents the development of infection or helps to manage or decrease pain.
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A good latch is considered important as the body recognizes and adjusts the milk production based on the infant’s intake.
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Tight-fitting bras must be avoided.
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Maintenance of personal hygiene before and after breastfeeding is mandatory.
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Massaging the breast during breastfeeding helps prevent the clogging of milk.
Conclusion
Breast infections are commonly seen in lactating mothers and are usually due to bacteria such as Staphylococcus aureus. Symptoms associated are swelling of the breast, pain, itching, etc. Lactational mastitis usually reduces within 24 to 72 hours if mild and gets completely cured within 10 to 14 days with medications. If pain or swelling is noticed, a healthcare provider must be immediately consulted; however, breastfeeding must be continued regularly to prevent clogging of ducts and the progression of infection.
