An Update on the Recognition and Management of Lactational Breast Inflammation

Christine M. Betzold, NP, CLC, MSN

Disclosures

J Midwifery Womens Health. 2007;52(6):595-605. 

In This Article

Recurrent Mastitis and Abscesses

We know very little of the etiology of recurrent mastitis, although delayed care and/or inadequate treatment can lead to recurrent breast inflammation.[2,17] Nonetheless, when recurrent mastitis does occur, it is important to try to prevent future episodes by identifying the underlying etiology. The most common etiologies to consider are milk stasis, infectious processes, and/or underlying maternal conditions. These processes may be interrelated. For example, a mother may have a chronic bacterial infection that leads to recurrent plugged ducts. First, consider causes of milk stasis, such as improper breastfeeding practices, external pressure on the breast, and/or oversupply. Abnormalities of the ducts or breast masses have been also known to cause milk stasis. Breast masses may mimic mastitis.[2,17] Next, consider the following infectious etiologies: 1) secondary fungal or yeast infections; 2) delayed care and/or inadequate antibiotic treatment; 3) chronic bacterial infections; and 4) the use of contaminated topical nipple ointments. Chronic bacterial infections can develop if the mother is treated less than 10 days, or there might be a small loculated area in the breast that needs treatment longer than 10 days for resolution. It is important to consider trauma following physical abuse. Finally, consider underlying maternal factors, such as fatigue, anemia, or stress. One intriguing study found low levels of immunoglobulin A (IgA), complement 3 (C3), and lactoferrin in the milk of mothers with recurrent infectious mastitis when compared to the milk of lactating mothers who did not have recurrent mastitis.[14,17] Correspondingly, one study found undetectable levels of milk IgA in a mother with recurrent plugged ducts. This finding led to a diagnosis of maternal IgA deficiency.[16]

Regardless of the etiology, recurrent mastitis necessitates prompt treatment, because it can cause widespread lesions and irreparable tissue damage, including breast disfigurement[2] and chronic inflammation.[2,17] Delayed care and/or inadequate treatment of recurrent mastitis may also lead to abscess (Figure 2).[17] Abscesses compromise lactation which can result in a functional mastectomy in 10% of women.[2] A functional mastectomy refers to a breast that is unable to effectively lactate (Figure 2).

Lactational abscess visually grossly apparent secondary to flaming redness, hemorrhagic area, swelling, and peeling skin.

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