“Doc, My Breast is Swollen and Painful”--Lactation Mastitis

She was woken up in the morning by a sharp pain in her left breast. She was shocked to see a large, red and tender swelling in the upper half of her breast. She felt slightly feverish and had chills.

K, 30, a first-time mum, had delivered her baby normally a month ago. Breast feeding was relatively easy. Her baby latched to her breasts well. Milk started flowing on the third day with ample supply and smooth flow.

On examination, there was a red, hot, tender fan-shaped swelling spreading from the nipple to the upper part of her left breast. The surrounding skin was tight and thickened. Her temperature was elevated at 38 degrees Celsius. K had inflammation of the breast-a condition known as lactation mastitis.

What causes lactation mastitis?

Mastitis is fairly common during the first 6 months of breastfeeding. It often happens when bacteria from the skin surface or baby’s mouth enters the breast through the nipple. This occurs more frequently if the mother has a cracked or sore nipple.

Mastitis can also result from a clogged milk duct due to incomplete emptying. The blockage causes the milk to get trapped and stagnated. This provides a good fertile ground for bacteria to breed.

What are the signs and symptoms?

As in the case of K, symptoms of mastitis can appear suddenly. They include:

• Hot, tender swelling of breast,

• Skin redness, often with an inverted triangular pattern with the lowest angle pointing towards the nipple,

• A breast lump may appear if pus starts to collect,

• Fever, chills and body aches,

• Painful lymph nodes in the armpit next to the infected breast.

What are the risk factors?