Mastitis is an inflammatory process in the tissues of the breast. It is manifested by severe bursting pains in the chest, swelling, compaction, redness of the gland skin, a sharp rise in body temperature, chills. Pathology is diagnosed with a visual examination by a mammologist, breast ultrasound is additionally possible. The disease can lead to the formation of an abscess, phlegmon, necrosis in the mammary gland, the development of sepsis and even death. In the case of microbial contamination of milk, breastfeeding will have to be stopped. In the long term, breast deformity may occur, the risk of developing mastopathy and breast cancer increases.
Mastitis is an inflammation of the breast tissue. Disease occurs as a result of infection of the breast with bacteria. It is manifested by swelling of the gland, an increase in size, soreness and increased sensitivity, redness of the skin and an increase in temperature.
The incidence of mastitis among nursing mothers ranges from 1% to 16%, depending on the region. On average, this indicator is equal to 5% of nursing women, and measures to reduce the incidence in recent years have so far been ineffective. The vast majority (85%) of women with disease are primiparous (or breastfeeding for the first time). This is due to a higher frequency of milk stagnation due to inept pumping. Women over thirty, who are not breastfeeding for the first time, get mastitis, as a rule, as a result of reduced protective properties of the body in connection with one or another concomitant chronic disease. In such cases, the symptoms are accompanied by clinical manifestations of the underlying disease.
Most often mastitis is caused by staphylococcal infection. But if there is a source of bacterial flora in a woman’s body (infections of the respiratory system, oral cavity, urinary tract, genitals), mastitis can be caused by her. Sometimes the mammary gland is infected with E. coli. Bacteria enter the mammary gland with blood flow and through the milk ducts.
Most often, mastitis develops as a result of prolonged pathological lactostasis (stagnation of milk in the gland). With a prolonged absence of milk outflow from any area of the mammary gland, a favorable environment for the reproduction of bacteria is formed there, the developing infection provokes an inflammatory reaction, fever, suppuration.
Mastitis is distinguished by the nature of the existing inflammatory process: serous, infiltrative, purulent, abscessing, gangrenous and phlegmonous mastitis. Serous, infiltrative and purulent mastitis represent successive stages of the inflammatory process in the gland tissue from the formation of a swollen area of serous inflammation, to the formation of infiltrate and the development of a purulent process.
With abscessing mastitis, the purulent focus is localized and limited, phlegmonous form is characterized by the spread of purulent inflammation through the gland tissue. With prolonged course or weakened body defenses, inflamed gland tissues necrotize (gangrenous mastitis). There are clinical types of mastitis: the most common is acute postpartum mastitis, plasmocellular mastitis and neonatal mastitis.
Acute postpartum mastitis is most often an inflammatory complication of lactostasis in nursing mothers. Sometimes it develops without the preceding pronounced signs of milk stagnation. It is manifested by the appearance of a painful seal in the mammary gland, redness and an increase in skin temperature in the area of the seal, fever and general symptoms of intoxication. With progression, the pain increases, the chest increases, becomes hot to the touch. Feeding and pumping is sharply painful, blood and pus can be detected in the milk. Purulent mastitis often progresses with the development of a breast abscess.
Plasmocellular mastitis is a rare disease that develops in older women who have repeatedly given birth after stopping lactation. It is characterized by infiltration by plasma cells of tissues under the nipple and hyperplasia of the epithelium of the excretory ducts. Such mastitis does not fester and has some external features in common with breast cancer.
Newborn mastitis is a fairly common condition in children of both sexes, manifested by swelling of the mammary glands, secretions when pressed on them (as a rule, it is the result of the residual effect of the mother’s sex hormones). With the development of acute purulent inflammation and the formation of an abscess, surgical sanitation of the purulent focus is performed, but most often the symptoms subside after three to four days.
The focus of inflammation in the mammary gland is determined by palpation. There is also an increase (sometimes moderate soreness on palpation) of axillary lymph nodes from the affected breast. Suppuration is characterized by the definition of a symptom of fluctuation.
When performing ultrasound of the mammary glands, a typical picture of inflammation of the mammary gland is found. Serous mastitis is characterized by smoothing of the echographic picture of differentiated structures of the gland, expansion of the milk ducts, thickening of the skin and subcutaneous tissue. The infiltrate in the mammary gland looks like a well-defined limited zone of reduced echogenicity, with progression there is a picture of “honeycomb”. The formation of abscesses is well visualized by ultrasound, and necrosis zones are revealed. The specificity and reliability of the technique reaches 90%.
Since the diagnosis of mastitis, as a rule, does not cause difficulties, mammography is usually not performed. If the ultrasound picture is questionable, an aspirate is taken for histological examination (a fine needle aspiration biopsy of the breast under ultrasound control). For bacteriological examination, you can take milk from the affected gland.
In the case of a sluggish course of inflammation and as a result of the formation of a fibrous tissue roller around it (bagging of the focus), the development of chronic mastitis is indicated. At the same time, clinical manifestations are usually poorly expressed, but palpation determines a dense sedentary focus, soldered to the skin.
At the slightest suspicion of the development of inflammation in the mammary gland, it is urgently necessary to consult a mammologist, since in the treatment of this disease it is very important to timely identify and immediately take measures to eliminate the cause of mastitis and suppress the infectious process. Self-medication or delaying treatment with a specialist is unacceptable, since inflammation of the breast is prone to progression, the formation of suppuration and abscess. In case of purulent mastitis, surgical treatment is necessary.
When mastitis is detected at the stage of serous inflammation or infiltration, conservative treatment of mastitis is carried out. Antibiotic therapy is prescribed with the use of strongly acting broad-spectrum agents. Serous mastitis in this case, as a rule, passes in 2-3 days, it may take up to 7 days for the infiltrate to dissolve. If the inflammation is accompanied by severe general intoxication, detoxification measures are carried out (infusion of electrolyte solutions, glucose). With severe excessive lactation, drugs are prescribed to suppress it.
Purulent forms of mastitis, as a rule, require surgical intervention. A developed breast abscess is an indication for emergency surgical rehabilitation: opening of mastitis and drainage of a purulent focus.
Progressive mastitis, regardless of its stage, is a contraindication to further breastfeeding (including healthy breast), since breast milk is usually infected and contains toxic tissue breakdown products. For a child, pathologically altered breast milk can cause the development of dysbiosis and disorders of the functional state of the digestive system. Since mastitis therapy includes antibiotics, feeding during this period is also not safe for the baby. Antibiotics can significantly damage the normal development and growth of organs and tissues. During the treatment of mastitis, milk can be expressed, pasteurized and only then given to the child.
Indications for the suppression of lactation: lack of dynamics in serous and infiltrative mastitis for no more than three days of antibiotic therapy, the development of a purulent form, the concentration of an inflammatory focus directly under the nipple, the existing purulent mastitis in the mother’s anamnesis, concomitant pathologies of organs and systems that significantly worsen the general well-being of the mother.
Measures to prevent mastitis coincide with measures to prevent lactostasis, since this condition is a precursor of mastitis in the vast majority of cases.
To prevent stagnation of milk, complete thorough emptying of the mammary glands is necessary: regular feeding and subsequent pumping of milk residues. If a child eats milk from one breast, in the next feeding, it is first applied to the gland that was untouched last time.
It is not necessary to allow the child to simply suck the breast to calm down, without sucking milk. Cracks on the nipples contribute to the development of inflammation of the mammary gland, therefore it is necessary to prepare the nipples for feeding, carefully observe hygienic rules (clean hands, breasts), properly apply the baby to the breast (the child should grab the nipple whole with his mouth, together with the areola).
One of the preventive measures for the development of mastitis can be called timely detection and sanitation of foci of infection in the body, but it is worth remembering that general antibacterial therapy during lactation is contraindicated.
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