Mastitis (Breast Inflammation) Treatment in Delhi, India

Mastitis is an inflammation of the breast tissue, commonly affecting women who are breastfeeding. It typically arises when a milk duct becomes blocked or infected, causing the breast to become painful, swollen, red, and warm to the touch. In addition to these physical symptoms, mastitis can also lead to systemic symptoms like fever and chills, which may make the individual feel unwell overall. The condition can disrupt breastfeeding and may require medical treatment to manage the infection and relieve symptoms. If left untreated, mastitis can lead to more severe complications such as abscess formation.

Mastitis can be broadly classified into two main categories:

Lactational Mastitis

This type of mastitis is common among breastfeeding women and typically arises when a milk duct becomes blocked or infected. The condition is often associated with poor breastfeeding practices, such as an improper latch or infrequent feeding, which can lead to milk stasis and bacterial growth. Symptoms include pain, swelling, redness, and warmth in the affected breast, along with systemic symptoms like fever and chills. In severe cases, abscesses may form, requiring additional medical intervention. 

Non-Lactational Mastitis

This category includes mastitis that occurs outside the context of breastfeeding and is not related to milk production. Causes can vary widely and include factors like injury or trauma to the breast, ductal ectasia (a condition where milk ducts become dilated and filled with thick fluid), or chronic inflammatory conditions. Symptoms may mirror those of lactational mastitis, such as pain, swelling, and redness, but the underlying causes differ. Non-lactational mastitis may also be associated with conditions like periductal mastitis or granulomatous mastitis, which require specific diagnostic and treatment approaches.

Mastitis can be caused by various factors, depending on the type:

Bacterial Infection: The most common cause of mastitis, particularly in lactational mastitis, is a bacterial infection. Bacteria, often Staphylococcus aureus, enter the breast tissue through cracked or sore nipples. This can lead to inflammation, pain, and swelling in the breast.

Blocked Milk Ducts: In breastfeeding women, a blocked milk duct can trap milk in the breast, creating an environment conducive to bacterial growth and infection. This blockage can be due to infrequent breastfeeding, improper latching, or tight-fitting bras.

Ductal Ectasia: In non-lactational mastitis, ductal ectasia is a condition where a milk duct beneath the nipple becomes dilated and filled with thick, sticky fluid. This can cause inflammation and lead to mastitis.

Trauma or Injury: Any injury to the breast, such as from a fall or impact, can cause inflammation and lead to mastitis. This can occur independently of breastfeeding or other conditions.

Chronic Inflammation: Conditions like periductal mastitis involve chronic inflammation of the ducts beneath the nipple, often related to smoking or other irritants. This chronic inflammation can lead to symptoms similar to those of infectious mastitis.

Autoimmune Disorders: In rare cases, autoimmune disorders can cause mastitis by triggering chronic inflammation in the breast tissue. Conditions such as granulomatous mastitis can lead to the formation of granulomas and persistent inflammation.

Nipple Piercing: If not properly cared for, nipple piercings can introduce bacteria into the breast tissue, potentially leading to infection and mastitis.

Several risk factors can increase the likelihood of developing mastitis:

Breastfeeding Difficulties: Issues such as improper latching, infrequent breastfeeding, or incomplete milk drainage can lead to blocked milk ducts and increase the risk of infection.

Cracked or Sore Nipples: Nipple damage can provide an entry point for bacteria, making the breast more susceptible to infection.

Engorgement: When the breasts become overly full of milk, it can lead to milk stasis and create an environment conducive to bacterial growth.

Weakened Immune System: Individuals with a weakened immune system due to conditions like diabetes, HIV, or other chronic illnesses are at a higher risk for infections, including mastitis.

Smoking: Smoking can impair the immune system and lead to chronic inflammation in the breast tissue, increasing the risk of mastitis.

Stress and Fatigue: High levels of stress and fatigue can affect overall health and immune function, making it easier for infections to take hold.

Nipple Piercing: Improper care of nipple piercings can lead to infections that may result in mastitis.

Previous History of Mastitis: Women who have had mastitis before are at a higher risk of developing the condition again, particularly if the underlying issues are not addressed.

Large Breasts: Women with larger breasts may have a higher risk of mastitis due to the increased likelihood of milk duct blockage and difficulty in maintaining effective breastfeeding techniques.

Certain Medications: Some medications that affect the immune system or hormonal balance can increase the risk of infections and mastitis.

Addressing these risk factors can help reduce the likelihood of developing mastitis and improve overall breast health.

The symptoms of mastitis can vary depending on the severity and type of the condition but typically include:

Breast Pain: Pain in the affected breast is one of the most common symptoms. The pain can range from mild to severe and may be constant or intermittent.

Swelling: The breast may become swollen and tender to the touch. The swelling is often localised, but can affect a larger area of the breast.

Redness: The skin over the affected area of the breast may appear red and inflamed.

Warmth: The affected breast may feel warm compared to the surrounding skin.

Flu-like Symptoms: Systemic symptoms such as fever, chills, and general malaise can accompany mastitis, indicating that the infection may be affecting the whole body.

Nipple Discharge: There may be a discharge from the nipple, which can be pus-like or bloody, especially if an abscess has formed.

Abscess Formation: In severe cases, a collection of pus may form an abscess in the breast, which can cause additional pain and require surgical drainage.

Swollen Lymph Nodes: Lymph nodes in the armpit or near the breast may become swollen and tender as the body responds to the infection.

These symptoms can impact daily activities and overall well-being, making it important to seek medical attention if mastitis is suspected.

Diagnosing mastitis typically involves several steps to confirm the condition and determine its cause. Here’s an overview of the diagnostic process:

Medical History and Physical Examination: The initial step involves a thorough medical history review and physical examination by a doctor. They will assess symptoms, such as pain, swelling, redness, and fever, and examine the breast for signs of infection or abscess formation.

Breast Ultrasound: An ultrasound may be used to visualise the breast tissue and identify areas of swelling, fluid accumulation, or abscesses. It helps distinguish between mastitis and other breast conditions.

Mammography: In some cases, a mammogram may be performed to rule out other conditions, such as breast cancer, especially if there are atypical features or if the mastitis does not respond to treatment.

Milk Culture: If an infection is suspected, a sample of milk may be taken and cultured to identify the specific bacteria causing the infection. This helps guide appropriate antibiotic treatment.

Blood Tests: Blood tests can be conducted to check for signs of infection and to assess overall health. Elevated white blood cell counts and other markers may indicate the presence of an infection.

Fine Needle Aspiration: If an abscess is suspected, a fine needle may be used to withdraw a sample of fluid from the breast. This can help confirm the presence of pus and guide treatment.

Biopsy: In rare cases where the diagnosis is uncertain or if there are unusual findings, a biopsy of breast tissue may be performed to rule out other conditions, such as cancer.

These diagnostic methods help ensure an accurate diagnosis of mastitis and enable the development of an effective treatment plan tailored to the individual's needs.

The treatment for mastitis depends on the severity of the condition and its underlying cause. Common treatment options include:

Antibiotics

When mastitis is caused by a bacterial infection, antibiotics are essential for clearing the infection. Typically, broad-spectrum antibiotics are prescribed. In cases where symptoms persist or if the infection is severe, a milk culture may be done to identify the specific bacteria, allowing the healthcare provider to prescribe a more targeted antibiotic. 

In cases of bacterial infection, antibiotics are the primary treatment for mastitis. If the infection is accompanied by unusual symptoms, such as nipple discharge, further evaluation may be needed to determine whether nipple discharge treatment is required alongside antibiotics.

The patient must finish the entire course of antibiotics, even if they start feeling better before the medication is completed, to prevent the infection from returning or worsening.

Pain Relief and Anti-inflammatory Medication

Over-the-counter medications can help alleviate pain and reduce the inflammation associated with mastitis. These medications also help manage fever, which is a common symptom of mastitis. In some cases, a stronger pain reliever might be recommended if the pain is severe. It's important to note that these medications are generally safe to use while breastfeeding.

Frequent Breastfeeding or Pumping

Continuously breastfeeding or expressing milk is vital for treating lactational mastitis. The process helps to clear any blockages in the milk ducts and prevents milk stasis, which can worsen the infection. It’s essential to ensure proper latching techniques, as poor latch can lead to incomplete milk drainage and contribute to mastitis. If breastfeeding is too painful, using a breast pump can help drain the breast effectively without causing additional discomfort. Consulting a lactation specialist may be beneficial in these cases.

Warm Compresses and Breast Massage

Applying warm compresses to the affected area before breastfeeding or pumping can promote milk flow and relieve some of the discomfort. The heat helps to dilate the milk ducts, allowing for easier milk passage. Gently massaging the breast in a circular motion towards the nipple can also aid in clearing any blockages in the ducts. This method is particularly effective when combined with frequent breastfeeding.

Abscess Drainage

If an abscess forms as a result of untreated or severe mastitis, it must be drained to prevent further complications. The abscess can be drained using needle aspiration, where a fine needle is used to withdraw the pus, or through a small surgical incision. In either case, it’s important to continue with antibiotics and other treatments to fully resolve the infection.

Mastitis, if left untreated or inadequately managed, can lead to several complications, including:

Breast Abscess: One of the most common complications of severe or untreated mastitis is the formation of a breast abscess. This occurs when pus collects in the breast tissue, leading to a painful lump that requires drainage either through needle aspiration or surgical intervention.

Chronic Mastitis: Recurrent or unresolved mastitis can develop into a chronic condition, where the inflammation becomes persistent. This is more common in non-lactational mastitis and can lead to ongoing pain, swelling, and discomfort.

Sepsis: In rare cases, if the infection spreads beyond the breast tissue into the bloodstream, it can lead to sepsis, a life-threatening condition. Symptoms include high fever, rapid heart rate, difficulty breathing, and confusion, requiring immediate medical intervention.

Milk Supply Issues: Mastitis can temporarily reduce milk supply in the affected breast, which can cause breastfeeding difficulties. In severe cases, long-term damage to the milk ducts may occur, potentially leading to a permanent reduction in milk production.

Scarring of Breast Tissue: Severe infections, especially those that lead to abscesses or repeated mastitis episodes, can result in the formation of scar tissue within the breast. This can cause changes in the breast’s appearance and texture and may affect milk flow in the future.

Fistula Formation: Chronic infections can lead to the development of abnormal connections between the milk ducts and the skin, known as fistulas. These require surgical repair and can complicate breastfeeding.

Preventing mastitis involves taking steps to ensure proper breast health, especially during breastfeeding. Some key preventive measures include:

Frequent and Complete Breastfeeding: Ensure regular breastfeeding or pumping to avoid milk stasis, which can lead to blockages in the milk ducts. Feeding frequently on both sides helps keep the milk flowing and prevents build-up. Make sure to empty the breast during each feeding.

Proper Latching Technique: Ensuring that the baby is latching properly during breastfeeding helps prevent nipple trauma and ensures efficient milk flow. Consulting a lactation specialist for assistance with latching can help prevent complications that lead to mastitis.

Vary Breastfeeding Positions: Changing breastfeeding positions can help fully drain all areas of the breast, reducing the risk of clogged milk ducts. Try different positions to ensure complete emptying.

Avoid Tight Clothing and Bras: Wearing bras or clothing that are too tight can compress the breasts and lead to blockages in the milk ducts. Opt for comfortable, supportive, and well-fitted bras, especially while breastfeeding.

Maintain Good Hygiene: Keep the nipples clean and dry between feedings to reduce the risk of bacterial infections. Wash hands before breastfeeding and handle breast pumps or other devices with care.

Address Breastfeeding Problems Early: If any breastfeeding issues arise, such as nipple pain, cracks, or incomplete breast drainage, seek help early to prevent them from escalating into mastitis.

Stay Hydrated and Rested: Maintaining proper hydration and ensuring adequate rest are important for breastfeeding mothers. A well-hydrated body promotes milk flow, and rest helps boost the immune system, reducing the risk of infection.

Promptly Treat Blocked Ducts: If a duct becomes clogged, apply warm compresses and massage the area to relieve the blockage before it turns into mastitis. Continuing to breastfeed from the affected breast can also help clear the blockage.

By following these steps, the risk of developing mastitis can be significantly reduced

Can I continue breastfeeding if I have mastitis?

Yes, it’s safe to continue breastfeeding if you have mastitis. In fact, breastfeeding or pumping helps clear the milk ducts, which can reduce symptoms and speed up recovery. It’s important to ensure proper latching to prevent further issues. If breastfeeding is too painful, try pumping to keep the milk flowing.

How long does it take to recover from mastitis?

Recovery from mastitis typically takes about 1 to 2 weeks, especially if you start treatment early. If antibiotics are prescribed, you should begin to feel better within a few days, but it’s important to complete the full course of medication to prevent the infection from returning.

Is mastitis contagious?

No, mastitis is not contagious. It’s usually caused by blocked milk ducts or bacteria entering through cracked nipples. It cannot be spread from person to person, even through breastfeeding.

What should I do if mastitis recurs?

If mastitis keeps coming back, talk to your doctor or a lactation consultant to identify any underlying causes, such as poor latching or incomplete breast drainage. You may need to adjust your breastfeeding technique or take additional steps to prevent blockages and infections.

Can mastitis affect only one breast, or can it occur in both?

Mastitis typically affects one breast at a time, but both breasts can develop mastitis, either simultaneously or at different times. However, this is less common.

Does having mastitis increase my risk of developing breast cancer?

No, having mastitis does not increase your risk of developing breast cancer. While mastitis can cause inflammation and swelling, it is unrelated to breast cancer. However, if you notice a lump that doesn’t go away after treatment, it’s a good idea to get it checked by your doctor.

When should I see a doctor for mastitis symptoms?

You should see a doctor if your symptoms don’t improve within 24–48 hours, if you develop a high fever, or if you notice a lump that becomes more painful. Also, seek medical attention if you have recurrent mastitis, as it may indicate an underlying issue.

Reviewed By Dr. Suneet Kaur Malhotra - Associate Director, Obstetrics And Gynaecology, Robotic Surgery, Gynaecologic Laparoscopy on 27 Nov 2024