Acute mastitis is an acute purulent infection of the mammary gland, an inflammation of the connective tissue in and around the ducts of the mammary gland, which occurs in postpartum lactating women, especially in primiparous women. It is a very common occurrence in postpartum lactating women, especially in primiparous women.
It is often secondary to nipple cracking, overfilling of the breast, and blockage of the milk ducts.
Causes
1, nipple cracking
Usually due to incorrect breastfeeding posture, the baby does not suck the nipple and most of the areola in the mouth, and fixed on one side of the breastfeeding time is too long.
2, blockage of the milk ducts
Commonly seen in secondary lactation, incomplete emptying of the breast, irregular frequent breastfeeding and local pressure on the breast are its main causes. Milk stagnation is also seen in those with poorly developed nipples (such as sunken nipples), which affects the breastfeeding process. In addition, the milk of new mothers contains more exfoliated epithelial cells, which is more likely to cause blockage of the milk ducts, making the stagnation of milk worse.
3, bacterial invasion
The main pathogenic bacteria of acute mastitis are Staphylococcus aureus and, less frequently, Streptococcus.
(1) Bacteria can invade directly through the milk ducts, which are easily infected due to the retention of milk. Because the retained milk is easy to decompose, the product of decomposition is acidic not only to stimulate the milk ducts, but also is a good culture medium for bacteria to multiply.
(2) Bacteria can enter through small wounds or cracks in the nipple and invade the interstitial lobe of the breast through the lymphatic vessels to form cellulitis.
(3) Pathogenic bacteria infecting other parts of the maternal body during the puerperium can cause breast infection via the blood circulation.
(4) Another way of infection is that the pathogenic bacteria in the baby (such as oral and nasopharyngeal infections) directly invade the lobules of the breast along the breast ducts retrogradely during breastfeeding and grow and multiply in the stagnant milk, causing mammary gland infection.
4.Milk stagnation
(1) The new mothers are inexperienced in breastfeeding and have a lot of milk, so babies often cannot suck up all the milk, resulting in the accumulation of extra milk in the lobules, which is conducive to the growth and reproduction of bacteria. The milk of new mothers contains more exfoliated epithelial cells, which can easily cause blockage of the milk ducts and aggravate milk stagnation. The stagnation of milk contributes to the development of acute inflammation.
(2) The new mothers do not often scrub the nipples during pregnancy, the epithelium is fragile, children sucking for too long, the nipple epidermis soaked soft, prone to chaps, chaps occur after the infant sucking causes severe pain to the mother, affecting the full breastfeeding, the breast is not easy to empty, the milk is easy to stagnate. In addition, the nipples are poorly developed, short, flat, small, sunken, etc., and the milk is more likely to accumulate.
Clinical manifestations
1.Stagnant mastitis
It occurs in the early puerperium (often about 1 week after delivery). It is caused by the lack of experience in feeding and nursing children, which makes it easy for milk to accumulate and not be emptied on time. Patients feel varying degrees of swelling and pain in both breasts and have a moderately elevated body temperature (about 38.5°C). On examination, the breasts are swollen, slightly red (engorged), and painful to pressure, but the symptoms mostly disappear after the milk is sucked out. However, if the nipple is not treated in time, or if it is small and is sucked by the newborn, the trapped milk can be contaminated by septic bacteria. Therefore, it is necessary to empty the excess milk and pay attention to the cleanliness of the nipple.
2.Septic mastitis
Mostly due to staphylococcal or streptococcal infection through ruptured nipples. As mentioned earlier, the milk accumulates after childbirth and if it is not emptied in time, it can easily lead to infection. When bacteria invade the milk ducts and continue to invade the parenchyma, various types of purulent mastitis can develop.
(1) Inflammation spreads to the superficial lymphatic ducts, leading to dandruff-like lymphangitis. This is characterized by sudden onset of high fever, often accompanied by chills, breast tenderness, and localized red spots or red lines on the skin.
(2) Inflammation is confined to the connective tissue of the areola and forms a subareolar abscess.
(3) The infection spreads along the lymphatic ducts into the interstitial mammary gland and may cross the breast tissue from the surface to the base. An interstitial abscess is formed due to suppuration of the connective tissue. This abscess may be confined to a single breast lobe or may spread to the greater part of the breast.
(4) The infection spreads rapidly and reaches deep into the lax connective tissue of the posterior breast between the base of the breast and the pectoralis major muscle, forming a posterior breast abscess.
The area where the inflammation or abscess is located shows redness, swelling and pressure pain. If necessary, test puncture can be performed to extract pus for bacteriological examination and drug sensitivity test for reference when choosing antibiotics.
Treatment
1.Before abscess formation
(1) In the early stage, if the maternal systemic symptoms are mild and only milk stagnation is present, breastfeeding can be continued and active measures can be taken to promote the smooth discharge of milk and reduce stagnation. Use bandages or breast supports to hold up the breast, and patients with lactation stasis can continue to breastfeed and apply ice packs locally to reduce lactation.
(2) Local treatment of breast swelling or lump formation, local heat compress is conducive to the dissipation of inflammation, each heat compress 20-30 minutes, 3 times / day, serious cases can be used 25% magnesium sulfate wet compress.
(3) Use antibiotics to select sensitive antibiotics for Staphylococcus aureus, either oral or intramuscular injection or intravenous drip according to the condition.
2.Abscess has been formed
The incision should be made in a timely manner to drain the abscess, and the incision is usually radially centered on the nipple and areola; shallow abscesses under the areola can be made along the areola with an arc-shaped incision; abscesses located behind the breast should be made in the lower skin crease of the breast 1 to 2 cm with an arc-shaped incision.
Prevention
1.Keep nipples clean, wash them frequently with warm soapy water, and pay more attention to cleanliness if there is nipple invagination, and do not scrub with ethanol.
2, to develop good habits of regular breastfeeding, each time the milk will be sucked out, such as sucking can not be exhausted to squeeze out or do not let the baby sleep with the nipple.
If you have a broken nipple, stop breastfeeding, suck out the milk with a breast pump, and then breastfeed after the wound has healed.