Makindo Medical Notes

🤱 Mastitis causes a woman’s breast to become painful, inflamed, and red. It usually occurs within the first 3 months postpartum.

📖 About

• 🔥 Mastitis is a painful inflammatory condition of the breast, with or without infection.
• 💉 A breast abscess = localized pus collection, often a complication of mastitis.

🧬 Aetiology

• 👶 Lactational mastitis: Milk stasis → inflammation ± infection (Staphylococcus aureus most common).
• 🚺 Non-lactational mastitis: Often infective; associated with subareolar duct damage, diabetes, RA, corticosteroids, granulomatous mastitis.
• 🦠 Pathogens: S. aureus, Enterococci, anaerobes (e.g. Bacteroides). ➡️ Consider MRSA in recent hospitalization, surgery, haemodialysis, HIV, IV drug use, prior MRSA.

👩‍⚕️ Clinical

• Mastitis: Painful, red, swollen wedge-shaped breast; fever >38.5°C; systemic malaise.
• Breast abscess: Localised lump + redness, warmth, fluctuation ± fever.
• Red Flag – Inflammatory breast cancer: Can mimic mastitis. Look for lymph nodes, nipple discharge, peau d’orange, skin thickening. If symptoms persist → urgent breast clinic referral.

🖼️ Diagram

🔬 Investigations

• 🧪 Pregnancy test (if indicated).
• 🍼 Breast milk culture if poor response to first-line antibiotics.
• 🖼️ Breast ultrasound → detects abscess.
• 📸 Mammogram if malignancy suspected.

💊 Management

• ✅ Prevent & support:
  • Encourage good breastfeeding technique (early skin-to-skin, unrestricted feeding).
  • Do not suppress lactation — continue breastfeeding/expressing from affected breast to relieve stasis.
  • Warm compresses + simple analgesics (e.g. paracetamol, ibuprofen).
• 💊 Medical:
  • If infective: prescribe antibiotics (first-line flucloxacillin; erythromycin if penicillin-allergic). Follow local policy.
  • Reassure: usually resolves fully with treatment.
• 🔪 Surgical:
  • If abscess: refer for drainage (needle aspiration ± surgical incision). Send pus for culture.
• 🚨 Red flags:
  • If not resolving → exclude inflammatory breast cancer (urgent referral).
  • HIV-positive mothers: Mastitis ↑ viral load in breast milk. Advise to stop breastfeeding → switch to formula; express and discard milk until resolved.

📚 References

• NICE Guidance: Mastitis & Breast Abscess
• MDU Case: Breast abscess vs cancer
• WHO Mastitis: Causes & Management
• NHS Leaflet: Mastitis & Breastfeeding
• BHIVA: HIV & Breastfeeding