Mastitis

Background:

Mastitis is a spectrum of conditions resulting from ductal inflammation and stromal oedema, and is a common condition in lactating women with the reported incidence varying from 10% to 20% in the first six months postpartum. Inflammatory mastitis may lead to bacterial mastitis. The majority of cases occur in the first six weeks postpartum, but it can occur at any time during lactation.

Clinical features:

• Red, painful, swollen hot breast or segment of the breast
• Skin may be tight, shiny and with appearance of red streaks
• Elevated maternal temperature (38.5 C and above)
• Chills or flu-like aching and systemic illness

 Management (spectrum wide recommendations):

• Continue breastfeeding from both breasts
• If unable to continue direct breastfeeding, breastmilk should be expressed regularly but not aiming to ‘empty breasts’
• Ice/cold packs can be applied to the breast after feeding/expressing – every hour or more as desired
• Heat will vasodilate and can worsen symptoms but can provide comfort for some patients so should be restricted to being applied for a couple of minutes prior to feeding/expressing.
• Avoid deep massage of the breast. This can increase inflammation
• Educate how to perform lymphatic drainage massage
• NSAIDS, see HealthPathways for recommendations

Antibiotic therapy:

If symptoms of mastitis are mild and without systemic symptoms, conservative management (effective milk removal, supportive measures and medical interventions as above) may be sufficient.

If symptoms are not improving within 12-24 hours or if the woman has systemic symptoms, antibiotics should be commenced.

It is safe for women to continue breastfeeding while taking antibiotics for mastitis.

Laboratory investigations are not usually needed. However, breast milk culture and sensitivity testing should be undertaken if:

• there is no response to antibiotics within 2 days
• the mastitis recurs
• the patient is allergic to usual therapeutic antibiotics

If the breast is still tender, red or lumpy after 5 days of antibiotic therapy:

• a further 5 day course of antibiotic therapy may be needed
• Ultrasound investigation may be needed to rule out breast abscess

 Complications of mastitis:

Breast abscess can be avoided with prompt and appropriate management of mastitis.

Follow up care: Refer to a lactation consultant or contact the Mercy Hospital for Women Breastfeeding Support Service via phone: (03) 8458 4677 or email.

The Mercy Hospital for Women Breastfeeding support service recommends the following referrals via phone (03) 8458 46777 or fax (03) 8458 4205:

Lactation referral and consultation during pregnancy suggested for the following:

• Women with history of breastfeeding challenges (low supply, breastfeeding attachment difficulties, early weaning)
• Women who foresee breastfeeding challenges (hypoplasia, history of breast surgery)
• Diabetic women (Type I, II and Gestational)
• In utero diagnosis of cleft lip/palate or congenital condition (e.g. Down Syndrome)

Lactation referral and consultation for postnatal women suggested for the following:

• Ongoing nipple pain/damage
• Low milk supply
• Tongue tie
• Suboptimal infant weight gains
• Mastitis or abscess

Referral Inclusion criteria:

• Women who will birth at the Mercy Hospital for Women
• The baby is under the age of three months
• Woman birthed at Mercy Health or have had a baby Special Care Nursery or NICU
• Women or their babies are in the care of Hospital in the Home (HITH)

For more information visit HealthPathways, the Academy of breastfeeding Medicine’s protocol or Dr Katrina Mitchell who is a physician, breast surgeon and Lactation Consultant (IBCLC) with a special interest in Lactation and mastitis.