Acute mastitis is an acute purulent infection of the mammary glands, mostly in postpartum breastfeeding women, especially in primiparous women, and often occurs 3-4 weeks after delivery.
Etiology
1, the stagnation of milk: the stagnation of milk is conducive to the growth and reproduction of invasive bacteria. The causes are: ① small or sunken nipples, preventing breastfeeding, pregnant women fail to correct the nipple sunken in time before delivery, the baby has difficulty sucking milk; ② too much milk, emptying incomplete, the mother did not empty the excess milk in the breast in time. ③ Milk duct inaccessibility, inflammation of the milk duct itself, tumor and external pressure, the fibers shed from the bra can also block the milk duct. Liu Zeyu, Breast Surgery Department, Chengdu Women’s and Children’s Center Hospital
2, the invasion of bacteria when the nipple invasion infant sucking difficulties, easy to cause the nipple around the break, is the main way of bacteria along the lymphatic vessels invasion caused by infection. In addition, infants often sleep with the nipple, but also can make the infant oral inflammation directly invade and spread to the milk ducts, and then spread to the interstitial mammary glands to cause purulent infection. Staphylococcus aureus is the common causative agent.
Clinical manifestations
Acute simple mastitis is characterized by swelling and pain in the breast, high local skin temperature, pressure pain, hard nodules with unclear borders and tenderness.
2, acute purulent mastitis local skin redness, swelling, heat, pain, more obvious hard nodes, tenderness, while the patient may appear chills, high fever, headache, weakness, rapid pulse and other general symptoms. At this time, swollen lymph nodes may appear in the axillae, with tenderness, and the blood leukocyte count of laboratory tests may rise, and sepsis may be combined in severe cases.
3, abscess formation due to ineffective treatment or further aggravation of the disease, local tissue necrosis, liquefaction, foci of infection of varying sizes fuse with each other to form an abscess. The abscess may be unicompartmental or multicompartmental. Superficial abscesses are easily detected, while deeper abscesses are less volatile and less easily detected. If a patient with mastitis has significant systemic symptoms and local and systemic medications are not effective, attention should be paid to the diagnosis of abscess by puncturing the painful area and waiting for the pus to be extracted or for a smear to reveal the version of cells.
Pathogenesis
Acute mastitis has three stages of onset, different stages have different manifestations and different treatment methods, therefore, it is important to understand the various stages in its onset.
The first stage is often nipple cracking, feeling nipple tingling when breastfeeding, accompanied by poor milk accumulation or lumps, and sometimes one or two milk ducts can be blocked. This is followed by localized swelling and pain in the breast, with or without lumps, accompanied by pressure pain, non-red or slightly red skin, and non-warm or slightly warm skin. The systemic symptoms are not obvious, or accompanied by chills and fever, chest tightness and headache, irritability and easy to lose temper, and loss of appetite.
2.Pus-forming stage The affected breast lumps do not disappear or gradually increase in size, with increased local pain, or pulsating pain, or even persistent severe pain, accompanied by obvious tenderness, red skin color, burning skin, and strong fever that does not subside, thirst and drinking, nausea and anorexia, and swollen and painful axillary lymph nodes on the same side. By the 10th day or so of breast redness, swelling and heat pain, the center of the breast lump gradually becomes softer and softer, and there is a fluctuating feeling when pressed, local diffuse swelling and heat, pressure pain is obvious, there is pus in the puncture aspiration, sometimes pus can flow out from the breast orifice, and the systemic symptoms intensify.
3.Post-rupture stage When the acute abscess is mature, it can break out the pus by itself or be excised and drained by surgery. If the pus comes out freely, the local swelling and pain will be reduced, the fever and cold symptoms will disappear, and the sore will gradually heal. If the pus does not come out smoothly after ulceration, the swelling does not subside, the pain does not subside, and the fever does not subside, pockets of pus may form, or the pus may spread to other breast ligaments to form transcystic canker sores. There are also cases where milk overflows from the sore after ulceration, and the sore is not healed for a long time, forming a breast leak.
Diagnosis and Differential Diagnosis
Acute mastitis mostly occurs during lactation in primiparous women, with an acute onset and a limited red, swollen, hot, painful lump in the breast, accompanied by chills, fever and other symptoms of systemic toxicity. When acute inflammation is not controlled in time, abscesses develop rapidly after a few days, and the diagnosis is confirmed by local puncture and aspiration of fluid. Acute mastitis should be distinguished from inflammatory breast cancer: ① Acute mastitis occurs initially in one part of the breast, while inflammatory breast cancer cells extensively infiltrate the skin reticular lymphatics, so the lesion involves most of the breast, and the skin has an orange peel-like appearance; ② Inflammatory breast cancer can be palpated in the breast with a large lump and extensive skin redness, but local pressure pain and systemic toxic symptoms are mild, and aspiration cytology can find The diagnosis can be confirmed by aspiration cytology.
Treatment
1. Treatment of acute mastitis in the period before abscess formation.
(1) Measures to promote the smooth discharge of milk (such as sucking out milk with a breast pump, breast massage to drain milk, etc.) and removal of milk stagnation factors.
(2) local physiotherapy, hot compresses, Chinese herbal medicine external compresses, conducive to the early dissipation of inflammation; edema is obvious with 25% of magnesium sulfate wet hot compresses or mannitol external compresses.
(3) Systemic anti-infection: apply antibiotics (cephalosporins, ofloxacin, metronidazole).
(4) Chinese medicine treatment: to soothe the liver and clear heat, stagnation and breast milk.
2, acute mastitis abscess formation period.
The treatment should be timely incision and drainage or minimally invasive surgery: abscess puncture and irrigation, placement of a tube for irrigation and drainage, drainage of accumulated pus. The key is to prevent milk stagnation, while avoiding nipple damage and keeping the area clean. In the second trimester (especially in the first trimester), both nipples should be washed frequently with warm soapy water; if the nipples are sunken, they can generally be corrected by frequent squeezing and pulling (some require surgery). To develop good breastfeeding habits such as regular breastfeeding, babies do not sleep with nipples. Every time you breastfeed, you should empty the milk, and if there is any stagnation, you can use a breast pump or massage to help empty the milk. The nipples should be washed after breastfeeding. If you find that your nipples are broken or ruptured, treat them promptly. Pay attention to the baby’s oral hygiene and treat oral inflammation promptly.