Mastitis


DEFINITION
Generalised cellulitis of breast tissue, being reasonably common in premenopausal women.
See also breast abscess.
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INCIDENCE

Risk Factors
Especially common in the early weeks of breastfeeding
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AETIOLOGY
Staph aureus is typical cause.
Strep possible.
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BIOLOGICAL BEHAVIOUR

Pathogenesis
Probably an ascending infection.
- beginning in subareolar ducts and extending out from nipple.
Influence of lactation
One or more breast ducts may become blocked during lactation by epithelial debris and discharge (or retraction of the nipple).
- stasis ensues in part of lactiferous tree.
- also possible that bugs introduced from baby's mouth to a sore and cracked nipple.
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MANIFESTATIONS

Local
Pain, tenderness, heat, redness, swelling in one part of breast
- spreads more rapidly if strep.
May spread or become chronic forming a lump / abscess.
Nipple discharge may be pus or bloody, and rejected by child.

Systemic
Unwellness and intermittent fever possible.

Signs
Classical inflammation observable.
Tense induration of skin.
Note if mass, abscess present that may require drainage, fluctuant, tense as progresses.
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INVESTIGATIONS

USS if unsure whether a collection exists.
Exclude inflammatory carcinoma if it is a possibility.
- clearly that would not rapidly improve with antibiotics
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MANAGEMENT

Conservative

Heat / ice packs
Massage to decompress the plugged duct
Mechanical breast pump to affected side.

Medical

Broad-spectrum antibiotics with good staph cover
(E.g. augmentin).

Operative
Drain an abscess if present.
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