Lactational Mastitis

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Definition

-  Localised painful inflammation of breast in a breast feeding mother associated w systemic S/S

 

Features

-  Usually unilateral

-  2-10% breast feeding women

-  May progress to abscess

-  Recurrent episodes or recalcitrant to treatment must exclude inflammatory breast cancer

-  Clinical Dx

-  Post partum infection

 

Associated S/S

-  Fever >38o, chills

-  Myalgia, malaise

-  Hard tender swollen area of one breast

-  Tender lymphadenopathy (reactive)

-  Eryhthema: cellulitis

-  Fluctuance: abscess

 

Risk Factors

-  Mastitis with previous child

-  Severe prolonged unilateral engorgement

-  Poor milk drainage

-  Nipple excoriation & cracking

 

Complications

-  Cellulitis

-  Breast abscess

-  Sepsis

 

DDx

-  Inflammatory breast cancer: thickened, erythema, peau doragne, axillary lymphadenopathy

-  Engorgement: bilateral & generalised

-  Plugged duct: nil systemic S/S

-  Galactocoele (milk retention cyst): soft cystic mass, non-tender, nil systemic S/S

 

Causes

-  Staph aureus +/- MRSA

-  Strep pyogenes

-  E. Coli

-  Bacteroides

-  Cynaobacterium

-  Coagulase negative staph

 

Ix

-  If severe infection: breast milk culture

-  +/- FBE, CRP: infection

-  +/- US to DDx abscess

-  +/- Bx if suspecting inflammatory brest cancer

 

Mx

-  Symptomatic relief

-  Ice packs

-  Ibuprofen 200-400mg TDS to QID

-  Improvement of breast feeding technique

-  Breast feeding is safe & should be encouraged

-  Antibiotics

-  Prevent development of abscess

-  Fluclox/Dicloxacillin 500mg PO 6/24 for 5/7

-  Penicillin hypersensitivity: Cephalexin 500mg 6/24 for 5/7

-  Penicillin anaphylaxis: Clindamycin 450mg PO 8/24 for 5/7

-  If severe cellulitis commence on IV

-  If nil improvement after 48hrs Antibiotics

-  US to exclude abscess, inflam breast Ca

-  +/- surgical R/V for abscess

-  If recurrent consider Bx

-  Prevention

-  Frequent complete emptying

-  Optimisation of breast feeding

 

 

 

References

 

Upto Date: Lactational Mastitis Jan 2012

eTG: Mastitis Jun 2010