CAUSES OF BREAST INFECTION (MASTITIS)

The predominant cause of most breast infections is Staphylococcus aureus bacteria, commonly known for causing staph infections. Streptococcus agalactiae is the second most frequent causative agent.

For breastfeeding mothers, a blocked milk duct can lead to milk backup, creating an environment conducive to infection. Cracked nipples also elevate the risk of breast infection. Bacteria from the baby’s mouth can enter the breast and initiate an infection. These bacteria are often naturally present on the skin even without an active infection. If they penetrate the breast tissue, they can rapidly multiply and cause painful symptoms. It is generally safe to continue breastfeeding even with a mastitis infection, as the bacteria are not typically harmful to the baby. This condition commonly arises in the initial weeks of breastfeeding but can occur later.

Non-lactational mastitis affects women with compromised immune systems, including those who have undergone lumpectomies with radiation therapy and individuals with diabetes. It’s important to note that some infection-like symptoms can be indicative of inflammatory breast cancer, though this is a very rare occurrence.

Subareolar abscesses can develop when glands located under the nipple become blocked, leading to an infection beneath the skin. This can manifest as a firm, pus-filled lump that may require drainage. This type of abscess typically occurs only in non-lactating women, and its specific risk factors are not well understood.

SYMPTOMS OF BREAST INFECTION

Symptoms of a breast infection can appear abruptly and may include:

• Abnormal swelling, causing one breast to become noticeably larger than the other

• Breast tenderness

• Pain or a burning sensation during breastfeeding

• A painful lump within the breast

• Itching

• Warmth in the breast

• Chills

• Nipple discharge containing pus

• Skin redness, often appearing in a wedge-shaped pattern

• Enlarged lymph nodes in the armpits or neck region

• Fever exceeding 101∘F (38.3∘C)

• A general feeling of being unwell or rundown

Flu-like symptoms may precede any noticeable changes in the breasts. It is advisable to contact a doctor if any combination of these symptoms is experienced.

Inflammatory Breast Cancer

Symptoms resembling a breast infection can also be associated with inflammatory breast cancer, a rare but serious disease. This cancer originates when abnormal cells in the breast ducts rapidly divide and multiply. These abnormal cells then obstruct the lymphatic vessels (part of the lymphatic system, which helps remove waste and toxins from the body) in the breast skin, leading to red, swollen skin that feels warm and painful to the touch. Breast changes can develop over several weeks.

Symptoms of inflammatory breast cancer may include:

• Thickening or visible enlargement of one breast

• Unusual warmth in the affected breast

• Discoloration of the breast, appearing bruised, purple, or red

• Tenderness and pain

• Dimpling of the skin, resembling an orange peel

• Enlarged lymph nodes under the arm or near the collarbone

Unlike other forms of breast cancer, inflammatory breast cancer typically does not present with palpable lumps in the breast. This condition is frequently mistaken for a breast infection. It is crucial to contact a doctor if any of these symptoms are experienced.

DIAGNOSIS

For breastfeeding women, a doctor can usually diagnose mastitis based on a physical examination and a review of symptoms. The doctor will also assess whether the infection has formed an abscess requiring drainage, which can be determined during the physical exam.

If the infection recurs persistently, breast milk samples may be sent to a laboratory to identify any present bacteria.

Other tests may be necessary to determine the cause of a breast infection in women who are not breastfeeding. Such testing might include a mammogram or even a biopsy of breast tissue to rule out breast cancer. A mammogram is an imaging test utilizing low-energy X-rays to examine the breast. A breast biopsy involves taking a small tissue sample from the breast for laboratory analysis to detect any cancerous cell changes.

TREATMENT

• Antibiotics: A 10- to 14-day course of antibiotics is generally the most effective treatment for this type of infection, with most women experiencing relief within 48 to 72 hours. It is vital to complete the entire prescribed course of medication to prevent recurrence of the infection. Breastfeeding can typically continue while on most antibiotics; if nursing is uncomfortable, a breast pump can be used to relieve engorgement and maintain milk supply.

• Incision and Drainage (I&D): If a severe breast infection leads to an abscess, it may need to be lanced (clinically incised) and drained. This procedure facilitates faster healing of the breast. Breastfeeding can continue, but guidance from a lactation consultant or healthcare provider on abscess care is recommended.

• Inflammatory Breast Cancer Treatment: If inflammatory breast cancer is suspected as the cause of symptoms, treatment will commence based on the cancer’s stage (severity). Treatment typically involves chemotherapy (using intravenous chemicals to eliminate cancer cells), radiation therapy (using high-powered X-rays to destroy cancer cells), or surgery to remove the breast and surrounding lymph nodes. It is important to remember that lumps and bumps during breastfeeding are very rarely cancerous; they are usually due to a blocked or swollen milk duct.

• Analgesics: For pain relief.

Self-care

While undergoing medical treatment for a breast infection, several home care steps can help alleviate uncomfortable symptoms:

• Warm compresses: Applying a warm, wet washcloth to the infected area for 15 minutes, four times a day, may ease pain and promote lactation.

• Empty the breast well.

• Anti-inflammatory medications: Such as ibuprofen (Advil, Midol), may help relieve pain.

• Use varied breastfeeding positions.

• Avoid prolonged engorgement: Feed or pump when it is time to prevent engorgement.

PREVENTION

• Prevent engorgement: Do not allow breasts to become engorged due to delayed feedings; feed or pump as needed.

• Ensure complete emptying: Aim to empty at least one breast thoroughly at each feeding, and alternate breasts. A nursing reminder clip for a bra can help track which breast was last used.

• Avoid sudden changes in feeding schedules.

• Avoid harsh nipple cleaning: Do not use soap or intense cleaning on the nipple area. The areola has natural self-cleaning and lubricating properties.

• Dietary supplements: Consider adding a small amount of lecithin or saturated fat to your daily diet to help reduce the risk of recurring plugged ducts. Sources include milk, meat (especially liver), and peanuts. Note that dietary supplements like lecithin are not monitored or approved by the FDA; always read labels carefully and compare brands.

• Massage the breasts: Especially if a thickening or lump is felt.

• Try different feeding positions: A baby is most efficient at draining ducts in the direction their chin is pointing.

• Apply warm wet towels: Place warm, wet towels on the breast before feeding to enhance milk flow.

• Avoid tight-fitting bras: Bras that are too tight can constrict and impede natural milk flow.

• Manage plugged ducts: If a plugged duct is felt, try breastfeeding, massaging the breast, applying heat, and changing the baby’s position.