Mastitis Mastitis refers to inflammation of the breast tissue with or without microbial infection. In lactating women, mastitis often presents as an acute onset characterized by an infectious inflammatory response, typically showing symptoms such as redness, swelling, heat, and pain. Non-lactational mastitis, on the other hand, has a chronic onset, with the presence of lumps and pain, and the condition is prone to recurrence. Mastitis can occur in women of any age, but it is predominantly observed in lactating women and is extremely rare in men. Early prevention and prompt treatment upon detection can help avoid or alleviate symptoms, generally leading to a favorable prognosis.

Mastitis refers to inflammation of the breast tissue with or without microbial infection. Mastitis during lactation often has an acute onset and is characterized by infectious inflammatory reactions, typically presenting symptoms such as redness, swelling, heat, and pain. Non-lactational mastitis tends to have a chronic onset with symptoms such as lumps, pain, and a tendency for the condition to recur. Mastitis can occur in women of any age, but it is most commonly seen in lactating women and is extremely rare in men. Early prevention and timely treatment can help avoid or alleviate symptoms, generally leading to a good prognosis.

Lactational Mastitis

Milk Stagnation

Provides an ideal growth medium for invading bacteria. Common reasons include poorly developed nipples (too small or inverted), excessive milk production, or insufficient breastfeeding leading to inadequate emptying of excess milk. Additionally, factors such as inflammation of the milk ducts, tumors, or external pressure can lead to blocked ducts, affecting milk drainage.

Bacterial Invasion

Bacterial invasion is a direct factor in the onset of the disease. Common causes include bacterial invasion along the lymphatic duct due to nipple injury or cracking, as well as direct entry of oral bacteria into the milk ducts or up to the lobules during breastfeeding or milk-sucking sleep.

Non-lactational Mastitis

The exact causes of these diseases are not yet clear. Currently, it is believed that plasma cell mastitis is mainly related to factors such as ductal obstruction, bacterial infection, a history of smoking (including secondhand smoke), and inverted nipples. Granulomatous mastitis tends to be an autoimmune-related disease, and its occurrence is also related to lactation factors, infection (especially by rod-shaped bacteria), and other factors such as trauma, hormonal levels, and oral contraceptive use.

Lactational Mastitis

Early stage: Breast swelling and pain, increased skin temperature, with tenderness and an unclearly defined hard mass in a specific part of the breast.

Inflammatory stage: Local skin of the breast becomes red, swollen, hot, and painful, with a distinct hard mass, exacerbating pain upon touch. Patients also experience systemic symptoms such as chills, high fever, headache, weakness, and rapid pulse. Additionally, there may be enlarged and tender lymph nodes in the armpit.

Further progression: Several days later, the affected area may undergo necrosis and liquefaction, forming an abscess. Superficial abscesses can rupture externally, while deep abscesses can penetrate into the loose tissue between the breast and chest muscles, forming a retro-mammary abscess.

Non-lactational Mastitis

Plasma cell mastitis and granulomatous mastitis have similar clinical manifestations. Plasma cell mastitis can occur in adult women of all ages, while granulomatous mastitis is most common in women of childbearing age, especially within 5 years after pregnancy. Both conditions mainly present as breast lumps, inverted nipples, nipple discharge, breast pain, and on a chronic basis, secondary acute infection can lead to the formation of abscesses, fistulas, or ulcers that persist.

In traditional Chinese medicine, mastitis is believed to be related to milk stasis, liver and stomach heat, and external pathogenic factors. Treatment mainly involves internal oral medication and external application of Chinese herbal medicine. The main principles of comprehensive treatment are clearing heat and detoxifying, resolving dampness and phlegm, promoting blood circulation and removing blood stasis, and reducing swelling and relieving pain.

Applying heated Golden Yellow Powder to the affected area can promote dilation of the breast ducts and local blood vessels, helping to alleviate local symptoms and reduce pain. Heat-clearing and detoxifying herbs such as dandelion and wild chrysanthemum can effectively alleviate symptoms.

Health education: Family members should encourage the patient to continue breastfeeding and provide guidance on proper feeding techniques.

Cold and hot compress: Cold compress can be applied to alleviate breast swelling, and hot compress before breastfeeding can help with milk drainage.

Ensure thorough milk expression: After each breastfeeding, ensure complete milk expression. Patients can gently massage from the most swollen part towards the nipple to help with milk expression. Some patients may use a breast pump to express milk thoroughly.

Ensure adequate rest: Family members should take on household chores to allow the patient to get sufficient sleep, which can help improve the body's immune function.

Relieve pain: Patients with severe pain can take painkillers such as acetaminophen or ibuprofen.

Reduce breast pressure: Wear a properly fitted bra and avoid compressing the breasts while sleeping.

Patients who develop mastitis during breastfeeding should generally not stop breastfeeding, as ceasing breastfeeding not only affects infant feeding but also provides an opportunity for milk stasis. However, breastfeeding from the affected breast should be stopped, and the milk should be expressed using a breast pump to ensure unobstructed milk drainage. Local heat compress can help dissipate early-stage inflammation.

If the infection is severe or if a breast abscess develops after drainage, breastfeeding should be stopped. Bromocriptine or ethinylestradiol can be taken orally, or estradiol benzoate can be injected intramuscularly until milk secretion stops.

To prevent lactational mastitis, apart from strengthening the resistance of pregnant women, the key lies in avoiding milk stasis, preventing nipple injury, and maintaining cleanliness. The exact preventive measures for non-lactational mastitis are not yet clear.

It is important to provide hygiene education during the perinatal period, instructing mothers to frequently clean both nipples with warm water and soap.

If there is nipple inversion, it should be regularly squeezed and corrected.

Developing good habits such as scheduled breastfeeding and ensuring that the baby does not sleep with the nipple in the mouth.

After each breastfeeding, ensure complete milk expression. If there is stasis, massage or use a breast pump to express milk thoroughly, and clean the nipples after breastfeeding.

Promptly treat nipple injuries or cracking.

Pay attention to the oral hygiene of the baby.