Mastitis is a common disease in women and can be divided into acute purulent mastitis, parareolar fistula, plasmacytic mastitis, etc. depending on the cause. Acute septic mastitis often occurs during lactation, especially within 1 to 2 months after delivery, so it is also called acute lactation or puerperal septic mastitis, which is called “canker sore” in Chinese medicine. The incidence of acute mastitis in primiparous women is as high as 2% to 4%, which is one times more than that of mastitis in menstruating women. It is an acute inflammatory disease with redness, swelling, pain, chills and high fever, and can be treated with breast milk drainage and Chinese herbal medicine in the early stage, but after suppuration, it requires incision and drainage. The onset of the disease is not only painful for the mother, but also prevents her from continuing to breastfeed and affects the health of her baby, so acute mastitis can be prevented by starting to prevent it from the second trimester of pregnancy and by providing good puerperal care.
Causes
Stagnant milk is the prelude and foundation of bacterial infection. When there is too much milk and poor drainage, the milk can stagnate into lumps. Stagnant milk is the best culture medium for bacteria. It is mostly caused by inexperienced or improper breastfeeding methods. The causative bacteria are mostly Staphylococcus aureus and a few are Streptococcus hemolyticus, which invade the breast parenchyma through the broken nipple skin or the milk ducts, multiply and destroy the breast tissue, forming multiroom abscesses. In case of nipple dysplasia, nipple depression, nipple entropion or splitting, the breast ducts do not discharge milk smoothly causing sludge. If the breastfeeding time is too long and the child “sleeps with the breast”, the nipple surface is rotten or the child bites the nipple and the bacteria enters through the breach; or due to cold, pharyngitis, the bacteria multiply in the stagnant milk through the bloodstream and become pus.
Postpartum weak immune system, wrapped too tightly, sweating more, not enough cleaning, local dampness of the breast, also provides a breeding ground for the growth and reproduction of bacteria. Mastitis is also easily induced by trauma such as extrusion and impact on the breast during breastfeeding.
Clinical manifestations
The clinical manifestations of acute mastitis can be divided into three phases or stages.
The first stage is the lumpy or red and swollen stage. The main manifestation is a sudden onset of swelling and pain in a part of the breast, usually the outer upper or inner upper quadrant, with unclear borders and mostly obvious pressure pain. At this stage, the inflammation within the breast is in the cellulitis stage and no abscess has formed. The color of the breast skin is normal or slightly red, or slightly hot. Sudden high fever and chills, painful swelling, local bright red, and soon pus breaks out, mostly accompanied by chest tightness and headache, loss of appetite, etc. If there is nipple cracking, the nipple will feel painful like pins and needles when breastfeeding, and one or two small pus spots or very small fissures can be seen on the nipple surface.
The second stage, abscess formation stage. The cellulitis stage does not dissipate in time, the inflammation continues to develop, tissue necrosis, abscess formation is inevitable. The lump gradually increases in size and hardens, and the pain increases, mostly pulsating throbbing pain, or even continuous severe pain, with localized redness and burning of the skin of the breast. The whole body has a strong fever that does not subside, thirst and desire to drink, nausea and anorexia, and the lymph nodes in the ipsilateral axilla are enlarged. After 2 to 3 days of redness, swelling and heat, the center of the lump gradually becomes softer and more volatile, the center is red and shiny, the skin becomes thinner, and the surrounding skin is bright red. Pus will be aspirated by puncture. At this stage, the abscess has become established and the time for conservative cure has passed.
Stage III, late stage of abscess ulceration. The abscess may break down by itself when it is mature, or it may be surgically incised to drain the pus. If the drainage is smooth, the local swelling and pain will be reduced, the body temperature will be normal, and the wound will gradually heal within about one month after changing medicine. If the pus does not come out smoothly after ulceration, the swelling does not subside, the pain does not decrease, and the fever does not subside, then the drainage is not smooth and does not heal for a long time to become chronic mastitis, which can also form a breast fistula, i.e. there is a mixture of milk and pus flowing out.
Examination
In acute mastitis, the diagnosis is usually made by clinical examination and palpation. The most common tests are blood work, elevated white blood cells or neutrophils, and ultrasound to determine the location and size of the pus cavity. A small amount of pus is taken for bacterial culture plus drug sensitivity test during puncture or incision to provide guidance for the application of antibiotics.
Diagnosis
The diagnosis of acute suppurative mastitis is relatively easy and can be made based on red, swollen and hot pain in the breast, a temperature as high as 39°C to 40°C, and an elevated blood leukocyte count. If the abscess is located deeper and the pus cavity is located in the posterior interstitial space of the gland, skin redness and swelling are often not obvious, at which point puncture to extract pus is required to confirm. If the abscess is not properly treated, the abscess forms slowly, the local mass does not disappear, the skin redness and systemic symptoms are not obvious, and chronic inflammation is formed, then it needs to be differentiated from other diseases.
Treatment
Acute mastitis should be treated as early as possible. In the early stages of mastitis, the inflammation is mainly bruised milk, which has not yet become pus, and can be treated with ultrashort wave physical therapy, which is more effective with Chinese medicine. The Chinese herbs used to clear the heat and detoxify the liver and promote breast milk dissipate within a week, commonly used guahu, gong ying, leaking reed, shanjia, bei mu, deer horn cream, etc., low fever with Chai hu, high fever with gypsum, constipation with burdock, milk with raw malt to reduce milk secretion. Because of the postpartum deficiency, it is forbidden to use bitter cold too much, and it is not advisable to use the genus Di Ding, Lian Qiao and Da Huang. You can continue to breastfeed during the medication or use the healthy side alone for breastfeeding. If high fever can be combined with infusion, penicillin, cephalosporin antibiotics can be. Note that it is not advisable to use a large amount of antibiotics too early. Excessive or prolonged use of antibiotics is the same as the result of too much bitter cold in Chinese medicine, that is, the lumps are difficult to disappear and easily turn into chronic. During the use of antibiotics, it is recommended not to breastfeed.
When acute mastitis reaches the stage of abscess formation, it requires prompt incision and drainage. The size and location of the incision is based on the principle of ensuring that the pus comes out unobstructed. Because breast abscesses are often multi-housed, it is necessary to separate the connective tissue intervals of multiple abscess cavities with the fingers in order for drainage to be unobstructed. For abscesses deep in the breast, with high fever and chills as the main symptoms, local redness and swelling are not obvious, and there is no sense of fluctuation, puncture and pus aspiration tests can be done first to confirm the presence of pus before incision. It is best not to wait for a breast abscess to break down on its own, because the abscess cavity is often multiple or one after another, and a self-ruptured break cannot drain completely. Generally speaking, as long as the pus comes out of the abscess and the fever subsides, the wound will enter the healing period and the medication will be changed every other day, and the wound will heal within one month.
Prevention
Acute suppurative mastitis is preventable and should be prevented as an integral part of health care for women in the puerperium. By understanding the causes of acute mastitis, prevention is not difficult. The key is two things: to prevent milk stagnation, to keep the breasts locally clean and to keep the mother physically and mentally healthy. In the last two months of pregnancy, it is important to be prepared for breastfeeding. First of all, keep both breasts clean and wash the nipples frequently with water or 3% boric acid water. Be careful not to use soap-based cleaning products to clean your breasts, because during pregnancy, the secretions of the sebaceous glands and sweat glands on the breasts will increase, and these substances can acidify the skin surface and thus play a protective role. If you often use soap to wash away the protective layer, or even wash away the grease that protects the skin of your breasts, it is easy for the surface of your breasts to become broken and cracked, and for germs to invade and cause infection.
The early sucking of the baby will stimulate lactation, which will not only increase the amount of lactation, but also promote the smooth discharge of milk and prevent bruising, which is very important for the prevention of mastitis.
If the nipple has congenital deformities, such as sunken or split nipples, you should find ways to correct them in the early and middle stages of pregnancy. Frequently pull the nipple by hand or use a breast suction device or negative pressure cupping device to suck out the nipple, once or twice a day. Sleep in the best position on your back to avoid squeezing your breasts sideways. Choose the right bra to not make your breasts feel compressed, and avoid external force against your breasts during your usual activities.
During breastfeeding, it is especially important to do the following five things to prevent and treat acute mastitis.
The first is to take supplements as needed, depending on the individual. Some mothers do not have a smooth start to their milk, so their families rush to stew fish soup and pig’s feet soup to supplement the mother’s body. In fact, this practice is not necessarily appropriate. The first thing is to distinguish the cause of low milk production. Is it due to low milk production or milk stagnation in the milk ducts? In other words, we need to identify whether it is a real milk deficiency or a pseudo milk deficiency. In many cases, milk has been secreted continuously, and more and more accumulates in the breast, but because the ducts are not yet open, they can not be discharged smoothly, giving the performance of “not much milk”, that is, pseudo milk less, at this time to supplement the milk food can only play a counterproductive role, which can easily lead to the occurrence of acute mastitis.
The second is to keep your breasts clean. The actual fact is that you can use gauze to clean your breasts and nipples with warm water after breastfeeding. Do not use chemical products like soap and alcohol to scrub your nipples, otherwise it will make your nipples local defenses decrease and dry out your nipples leading to bacterial infections.
Third, correct breastfeeding. Advocate regular breastfeeding, every 2 to 3 hours is appropriate. It is best to alternate breastfeeding between the two breasts, with equal opportunities, to prevent asymmetry between the two breasts after breastfeeding. Empty your breasts and do not accumulate milk. When one breast is full, you should empty the other breast with a breast pump. Do not let the baby sleep with the nipple in his mouth after breastfeeding, as the baby’s saliva contains digestive enzymes, which can cause the milk to form cheese-like substances and block the milk ducts, resulting in poor milk drainage and even stagnation. Breastfeeding posture should be correct, preferably in a sitting position, and less in a lying position. After breastfeeding, the baby should be held upright, with his head resting on the mother’s shoulder, and his back gently patted. This will allow the baby to expel the air inhaled during breastfeeding by burping and prevent spitting up. Wearing a suitable bra after breastfeeding can not only hold up the breast and keep the blood circulation inside the breast smooth, but also help correct sagging breasts.
Fourth, open breast massage. Women who give birth by caesarean section often have slow milk production and insufficient milk at the beginning, so they need timely milk opening massage. The duration of manual milk discharge should be 20 to 30 minutes each time, and the single time should not be too long. If a milk discharge does not work, simply increasing the massage time will only increase the probability of local edema. The correct technique of massage is to apply paraffin oil or Kaiser’s Lotion to lubricate the skin, slide your fingers from the outer edge around the breast to the areola, and then lift the nipple up and down several times, causing local negative pressure under the areola, so as to achieve a role similar to that of a baby sucking. In addition to the stimulation of massage techniques, the end of the massage can let the child sucking, to increase the drainage reflex, so that after the dual role of massage plus sucking, the effect will be better, can reduce the occurrence of acute mastitis.
The first is to keep the environment clean and emotionally stable, avoiding anger and anger. The temperature and humidity of the maternity room should be appropriate, generally 22°C to 24°C is appropriate, and the indoor air should be fresh. Some people think that women are afraid of wind, easy to sweat, cold and flu. So the doors and windows are closed tightly, the indoor air is dirty, which is not good for the mother and baby. In addition, the appropriate diet, bowel movements, emotional stability is important for the mother. The Chinese medicine believes that acute mastitis is the result of liver stagnation and gas stagnation and stomach fire. If the liver is depressed, the milk ducts will be blocked. If you are frightened and angry, your lactation will stop. So it is important to be in a relaxed mood, emotionally stable, and pay attention to prevent trauma to the breasts from being squeezed and hit, which are very important to prevent mastitis.
The bruised milk lumps can be cold compressed with ice packs, but not hot compresses, not just rubbing and pressing.