mastitis.pdf

Mastitis is inflammation of the breast tissue that can be caused by an engorged breast or a blocked duct.

1. MASTITIS
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2. MASTITIS
Prepared By:
Reena Bhagat
Senior Nursing Instructor
Maternal Health Nursing
BPKIHS

3. Breast: Basic Anatomy
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5. Introduction
•Mastitis is a localized painful infection of breast,
which can progress to an abscess if not treated
properly.
•It typically presents as a red, painful, firm , swollen
area of one breast with a fever> 38.3
0
C.
•The incidence of mastitis is 2–5 percent in lactating
and less than 1 percent in non-lactating women.
•The common organisms involved are
Staphylococcus aureus, S. epidermidis and
Streptococci viridans.
•Risk factors for mastitis are poor nursing, maternal
fatigue and cracked nipple.

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6. Definition
•Mastitis is inflammation of the breast tissue
that can be caused by an engorged breast or a
blocked duct.

•Mastitis is an inflammation of breast tissue that
sometimes involves an infection. The
inflammation results in breast pain, swelling,
warmth and redness.

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8. Mode of infection
There are two different types of mastitis depending
upon the site of infection.
1.Infection that involves the breast parenchymal
tissues leading to cellulitis. The lacteal system
remains unaffected.

2.Infection gains access through the lactiferous
duct leading to development of primary
mammary adenitis. The source of organisms is
the infant’s nose and throat.
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9. Contd..
Non-infective mastitis may be due to milk stasis.
Feeding from the affected breast solves the
problem.

Onset:
In superficial cellulitis, the onset is acute during
first 2–4 weeks postpartum. However, acute
mastitis may occur even several weeks after the
delivery.
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10. Clinical features
Symptoms include
a.Generalized malaise and headache,
b.Fever (102°F or more) with chills, and
c.Severe pain and tender swelling in one quadrant
of the breast.
Signs include
a.Presence of toxic features, and
b.Presence of a swelling on the breast. The
overlying skin is red, hot and flushed and feels
tense and tender
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11. Contd..
Complications:
Due to variable destruction of breast tissues, it
leads to the formation of a breast abscess.

Prophylaxis:
Thorough hand washing before each feed,
cleaning the nipples before and after each feed
and keeping them dry, reduce the nosocomial
infection rates.
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12. Diagnosis
•History taking
•Examination
•Investigations: A sample of breast milk should
be sent for bacteriological examination
including culture and sensitivity to confirm
diagnosis.

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13. Management
a.Breast support, and a good supportive bra.
b.Plenty of oral fluids,
c.Breast feeding is continued with good
attachment. Nursing is initiated on the
uninfected side first to establish let down,
d.The infected side is emptied manually with each
feed,
e.Dicloxacillin (penicillinase resistant penicillin)
is the drug of choice. A dose of 500 mg every 6
hours orally is started till the sensitivity report
available.
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14. Contd..
Erythromycin is an alternative to patients who are
allergic to penicillin. Antibiotic therapy is
continued for at least 7 days,
f.Analgesics (Ibuprofen) are given for pain,
g.Cold or ice compresses help with pain relief
until the process improves. Warm, wet
compresses may be ordered to reduce
inflammation and edema.
h.Milk flow is maintained by breast feeding the
infant. This prevents proliferation of
staphylococcus in the stagnant milk. The
ingested staphylococcus will be digested
without any harm.

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15. Breast Abscess
Definition:
Sometimes a bacterial infection can cause pus to
collect in a localized area just below the skin. When a
pocket of this pus forms in the breast it is known as a
breast abscess. It can be painful and requires urgent
medical treatment to avoid complications.
Features are
1.Flushed breasts not responding to antibiotics
promptly,
2.Brawny edema of the overlying skin,
3.Marked tenderness with fluctuation,
4.Swinging temperature
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16. Breast abscess
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18. Etiology /Causes
Breast abscess is caused by a bacterial infection. The
most common type of bacteria involved in a breast
abscess is Staphylococcus aureus.
Bacteria enter through a scratch in the skin or a tear
in the nipple. The resulting infection, called mastitis,
invades the fatty tissue of the breast and leads to
swelling and pressure on the milk ducts.

If mother is breastfeeding, risk of breast abscess can
be lowered by:
Preventing irritation or cracking of the nipples

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19. Contd..
If mother is not breastfeeding, risk of breast
abscess may be lowered by:
• Avoiding use of tobacco products smoking,
Diabetes, HIV infection.
•Maintaining a healthy weight
•Preventing irritation or cracking of the breast
skin and nipples.

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20. Clinical Manifestations
The most common symptoms of breast abscess
include:
Breast engorgement (swelling)
Breast pain
Itching
Nipple discharge
Nipple tenderness
Swelling, warmth and redness of the breast tissue
Tender or enlarged lymph nodes in the armpit on
the affected side.
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21. Diagnostic Evaluation
•History collection
•Physical examination
•Chest x-ray
•Breast Biopsy.
•FNAB(Fine Needle Aspiration Biopsy)
•Breast MRI(Megnatic Resoance imaging) Scan.
•Mammogram.
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22. Complications
The Potential Complications of Breast Abscess
•Chronic infection
•Chronic pain
•Disfigurement and scarring
•Organ failure
•Sepsis (life-threatening bacterial blood infection).
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23. Prevention Methods
•Do not breast feed with the infected breast if
abscess present.
•Keep the breasts clean by washing them daily with
mild soap and water. Wipe off dried secretions and
gently dry the breast thoroughly with clean towel.
•After breast feeding , wipe the nipples and areolae
with sterilized cotton dipped in boiled ,cooled water.
•At end of a feed, allow breasts to dry naturally in
the air.
•Apply a warm, moist compress to the affected area
several times a day.
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24. Management
•If an abscess is formed, it is to be drained under
general anesthesia by a deep radial incision
extending from near the areolar margin to prevent
injury of the lactiferous ducts.
•Finger exploration is done to break up the walls of
the loculi. The cavity is loosely packed with gauze
which should be replaced after 24 hours by a smaller
pack. The procedure is continued till it heals up.
•The abscess can also be drained by serial
percutaneous needle aspiration under ultrasound
guidance.
•Surgical drainage is commonly done.
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26. Contd..
•Breast feeding is continued in the uninvolved side.
•The infected breast is mechanically pumped every
two hours and with every let down. Recurrence risk
is about 10 percent. Once cellulitis has resolved
breast feeding from the involved side may be
resumed.
•Provide antibiotic therapy for 7-10 days
•Broad-spectrum antibiotic medications used to treat
breast abscess include:
Cephalosporins, such as cefazolin (Cefazil) or
cephalexin
Erythromycin
Penicillin's, such as penicillin G potassium.
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27. Contd..
Breast pain may be due to engorgement, infection
(Candida albicans), nipple trauma, mastitis or
occasionally with latching-on or let down reflex.

Management:
•Appropriate nursing technique, positioning and
breast care can reduce pain significantly when it
is due to nipple trauma, engorgement or mastitis.
•Use of miconazole oral lotion or gel into both the
nipples and into infant’s mouth thrice daily for 2
weeks is helpful.
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