Mastitis

Mastitis – Inflammation of the Breast

Mastitis describes various inflammations of the gland and skin of the breast. They may have a microorganism as their etiology or may be autoimmune. The picture of inflammation in the breast is similar to the rest of the body: Heat, Redness, Swelling, Pain, and Fever. They are generally divided into lactation and non-lactation mastitis, acute and chronic, microbial and autoimmune.

Distinction of mastitis from inflammatory breast cancer

The appearance of an inflammatory breast image requires immediate evaluation by a breast specialist to rule out Inflammatory Breast Cancer from the outset. This rare and very aggressive cancer is not a true inflammation of the breast, but the clinical picture is similar.

Types of mastitis and breast abscesses:

1. Lactation mastitis from milk stasis

This is the most common form of mastitis. It usually occurs at the beginning of breastfeeding, but it can occur at any time during breastfeeding when the breast is not fully empty. The stasis of milk, as it is called, can occur when:

• The infant does not touch the breast properly or is hindered by anatomical problems

.

• The infant is not latched on properly to the breast or is hindered by anatomical problems

.

• The breast is not latched on properly or is hindered by anatomical problems

.

• No breastfeeding due to a schedule or breastfeeding is too late

.

• One breast is much preferred to the other
• Breast pressure (e.g. from tight underwear)
• Trauma to the breast

  

It usually presents with swelling, pain, reddening of the skin and high fever. The immediate treatment is to empty the breast either by massage or breast pump. If the duct does not empty, your breast doctor can empty the milk with a guided puncture. Antibiotic treatment is the next step if the inflammation and fever persist. Neglected cases will form an abscess, which is emptied by puncture or surgical opening.

If the infection is not treated, the patient may be treated with a surgical procedure or surgery.

2. Lactation mastitis from nipple injury

.

It occurs when the baby injures the nipple from sloppy breastfeeding. Direct penetration of microbes from the skin into the breast tissue can cause localized subthyroid mastitis. Antibiotics are prescribed to treat mastitis. In neglected cases without treatment, an abscess may develop under the nipple. Because of the pain, breastfeeding is usually discontinued. Women who wish to breastfeed for a long time should take care of the hygiene of the nipple, especially when it is injured.

&nbsp?

3. Peripapillary mastitis and mastitis from ductal ectasia

The common form of mastitis that occurs outside of lactation is perithecal mastitis. It is caused when some milk ducts behind the nipple become damaged and allow microbes to penetrate the breast. Usually the microbe that causes it is staphylococcus skin fluke. Because smoking causes malformations of the milk ducts, most patients are smokers. Peripapillary mastitis occurs with the following symptoms:

• feeling of warmth behind the nipple

.

• The following symptoms are common:
• feeling of warmth behind the nipple
• Blushing around the nipple (or underneath it, if there is pore ectasia)
• Swelling of the area making it look like a tumor (!)
• Severe pain
• Nipple discharge (maybe bloody or white in case of ectasia)
• Nipple swelling (occurs due to swelling or ectasia of the papillae)
• Fever occurs in advanced conditions
• If not treated in time, it causes abscess formation

Your doctor will primarily make sure that it is a simple microbial inflammation and not something more serious. An experienced clinical examination and breast imaging tests (mammogram and breast ultrasound) will give a comprehensive picture. If there is any appearance of a tumour rather than inflammation, a guided biopsy under ultrasound should be performed immediately for histological identification. If there is a picture of inflammation only, antibiotics will be administered and resolution of symptoms with resolution of swelling, pain and redness will be expected. If there is no improvement, an antibiogram may be needed to search for a more active antibiotic. After complete remission of symptoms, a re-examination will follow to ensure that the breast is now completely normal.

&nbsp?

4. Chronic Peripheral Mastitis

Chronic Peripartum Mastitis is the continued occurrence of episodes of mastitis, tiring the woman over time. Repeated episodes of pain, abscess formation and taking large amounts of antibiotics are to be expected. The patients are usually smokers.

The definitive treatment is only surgical, by a qualified breast surgeon:

• Dissection of the milk ducts
  It is the operation of choice for chronic mastitis. The pores that allow microbes to enter the breast are removed entirely. This operation has an excellent aesthetic result, and in cases of invasive nipple, this deformity is corrected.
• Central breast excision including the nipple
  It is the last resort in very rare, severe situations, when all other treatment measures have failed.

5. Red cell mastitis

It is a rare form of autoimmune mastitis that can occur anywhere in the breast. An experienced specialist doctor will recognize it as a possibility in an atypical mastitis outbreak and perform a guided tissue biopsy, which is the only way to diagnose this disease. Correct diagnosis is of huge importance as it requires a different treatment approach (not with the usual antibiotics). It occurs as idiopathic or in the context of other rare chest infections. Examples include tuberculosis, brucellosis, leprosy, fungal and parasitic infections.

6. Breast abscess

Abscess formation is the natural outcome of a mastitis that was either not diagnosed in time or not treated properly. Abscess means the formation and collection of pus at the site of mastitis. It can occur in all the types of mastitis mentioned above. The treatment of abscess is as follows:

• Directed puncture of the abscess with a needle after local anaesthesia
  The puncture is done quickly and inexpensively in the office, guided by ultrasound. After administration of local anaesthetic, the abscess cavity is targeted with a large needle and the pus is removed. This can be done both therapeutically and diagnostically when we want to send material for culture and antibiogram.
• Surgical opening of the abscess
  It will be performed when paracentesis is not enough because the abscess is too large or has very dense contents. It can be done in the office under local anesthesia or under general anesthesia in the operating room.

7. Inflammation of the skin on the breast (breast dermatitis)

Breast skin inflammations are not true mastitis. They involve only the superficial layer of the skin and not the breast gland. Such inflammations are:

• Flecky sebaceous cysts of the breast.
  Sebaceous cysts, in addition to the rest of the body, can also occur in the breast. When at rest they resemble a superficial breast tumour and need investigation. When infected and inflamed, they resemble mastitis. They usually cause multiple episodes of inflammation. Your specialist doctor will make the diagnosis and advise you on treatment and the possibility of surgical excision.

• Breast and nipple dermatitis
  Skin inflammations such as eczema are likely to occur in the breast as well. They are often seen on the nipple, where they are accompanied by a feeling of intense itching. A definite diagnosis can be made with the simple procedure of breast skin biopsy. The biopsy will also help to rule out the possibility of Paget’s disease of the nipple, a malignant disease. Based on the results of the histological skin examination, we will proceed with appropriate treatment, perhaps with the input of a medical dermatologist.