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“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?

They include:

  • Sore or cracked nipples,

  • Too long an interval between breastfeeding,

  • Wrong or improper breastfeeding techniques,

  • Incomplete emptying of the breast from anxiety, being stressed or overly tired,

  • Poor nutrition,

  • Previous history of mastitis.

What could be the consequences?

Mastitis that is not adequately treated can lead to breast abscess when pus starts to collect. Surgical drainage may be necessary.

Lactation mastitis also makes the mother feel tired and run down. This may make it difficult for her to care for her baby. She may quit breastfeeding altogether or wean her baby off prematurely.

How is mastitis treated?

Mastitis usually responds to antibiotics, which will not harm the baby. A full course has to be taken. If initial treatment doesn't work, a sample of the milk may be sent to the laboratory for culture and sensitivity testing so that appropriate medication can be given.

Other measures include:

  • Encouraging the mother to drink plenty of fluid,

  • Applying hot or cold compress to the affected breast just before breastfeeding and hand-expressing or pumping of milk if necessary,

  • Giving pain killers before massage,

  • Massaging the affected breast from the periphery of the breast towards the nipple after placing a hot wet towel over the affected area for 10-15 minutes,

  • Breastfeeding from the affected breast first so as to move the milk through the breast faster,

  • Having ample rest between feeds.

K was treated with antibiotics and some anti-inflammatory drugs. Fortunately, her mastitis which was due to blocked ducts responded. The lactation consultant helped her to clear the blockage by doing deep massage using the knuckles while she was breastfeeding. K was also encouraged to feed the baby more frequently. Cold cabbage leaves were used to cover the affected breast between feeds to relieve inflammation and pain. The mastitis gradually subsided after two days. K was able to continue breastfeeding her baby for over 12 months.

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