Acute Mastitis Etiology

Written by Cui Yu Rong

Breast Surgery

Updated on September 23, 2024

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Acute mastitis generally refers to lactational mastitis, which can occur at any time during lactation, but is more common in the beginning stages of lactation in primiparous women. The most common causes of acute mastitis are milk stasis and bacterial invasion. Therefore, the prevention of acute mastitis mainly targets these two aspects. Besides enhancing the immune system of the mother, it is crucial to maintain good breastfeeding habits. This includes cleaning the nipples and the baby's mouth before and after feeding, keeping the nipple area clean, minimizing damage to the nipple area, and controlling bacterial invasion.

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Acute Mastitis Symptoms and Treatment

Patients with mastitis often feel pain in the breast, with localized redness, swelling, and fever. As the inflammation progresses, there can be chills, high fever, and increased pulse rate, often accompanied by swelling and tenderness of the lymph nodes on the affected side. A routine blood test can show a significant increase in white blood cells. For treatment, if there is swelling, it is recommended to stop breastfeeding and apply topical Levofloxacin. Blood tests should be checked, and if white blood cell count exceeds 10,000, intravenous antibiotics are advised. If below 10,000, oral anti-inflammatory drugs can be taken for symptomatic treatment. After three days, recheck the blood routine to decide on further symptomatic treatment.

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Acute mastitis is caused by what?

Mastitis is generally considered to be caused by the accumulation of milk, which occurs during breastfeeding when the posture or unintentional actions by the child cause damage to the milk ducts, leading to an accumulation of milk within them. Since milk serves as an excellent culture medium, this can lead to bacterial infection. The second point is that if there are cracks or fissures on the nipple, bacteria can infect in reverse, leading to significant infections by Staphylococcus aureus, which can also cause mastitis. The third point concerns a weakened immune system, for example due to mental stress or lack of sleep. These are the main causes of acute mastitis.

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Does acute mastitis require daily milk expression?

If acute mastitis is severe, breastfeeding is not advisable, and it is necessary to express milk daily. Prevention of acute mastitis is more important than treatment, especially during breastfeeding periods where it is crucial to keep the nipples clean. Frequently wash them with warm soapy water and clean the nipples before and after breastfeeding with 3% boric acid solution. For those with inverted nipples, gently extract the nipple before cleaning; however, do not use ethanol wipes as ethanol can make the nipple and areola skin brittle, which can lead to cracking. Develop good breastfeeding habits, nurse regularly, and ensure that the milk is thoroughly drawn out each time. If unable to completely draw out the milk, use hand massage to express it or a breast pump. Additionally, do not let the baby sleep with the nipple in their mouth. If there is nipple damage or cracking, stop breastfeeding and use a breast pump to express the milk until the wound heals, and then resume breastfeeding.

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The causes of acute mastitis

The first cause is milk stasis, which occurs when, due to incorrect positioning during nursing or breastfeeding, a child inadvertently causes the milk ducts to close, leading to a significant accumulation of milk within these ducts. The milk inside the ducts provides an excellent medium for bacterial growth. The second cause is bacterial invasion, mainly through cracks and fissures in the nipple. Bacteria enter the milk ducts through these fissures or breaks, causing inflammation. The third cause is a decrease in the body's immune function, for example due to severe mental stress or lack of sleep. All of these are the primary causes of acute mastitis.

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Can you breastfeed with a fever from acute mastitis?

For acute mastitis with fever, it is generally recommended to stop breastfeeding. For mild symptoms and less severe cases, breastfeeding is possible. However, do not breastfeed from the breast that is affected with redness, swelling, heat, and pain; instead, use a breast pump to extract the milk. For more severe symptoms or if an abscess has formed, breastfeeding must be discontinued. Further, a breast ultrasound should be performed to determine whether the issue is cystic or inflammatory. A complete blood count is also recommended to view the extent of the infection. If the count exceeds 10,000, intravenous antibiotics are necessary, and topical Levofloxacin can be applied locally. If the count is below 10,000, oral anti-inflammatory medications can be taken to treat the symptoms. (Please use medications under the guidance of a doctor.)