How is acute mastitis examined?

Written by Shen Li Wen
Obstetrics and Gynecology
Updated on May 01, 2025
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When suspecting acute mastitis in women, a routine physical examination should first be conducted, including measuring body temperature to check for any elevation, examining if the breast shape is symmetrical on both sides, and observing any congestion or swelling of the local skin, as well as feeling for any fluctuating sensation upon touch. This fluctuating sensation actually indicates an intensified manifestation of mastitis, resulting in a dense breast. Additionally, check whether the lymph nodes under both armpits are swollen, perform a blood draw to analyze a complete blood count, and understand the blood picture and whether there is an increase in neutrophil classification. If there is a consideration of abscess in the breast, a color ultrasound examination of both breasts should also be conducted. Under ultrasound guidance, aspiration of secretions for culture can be performed, which is informative for understanding the pathogen and guiding future medication use.

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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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Early treatment of acute mastitis

In the early stages of mastitis where there is pain but no redness and swelling, applying heat and then having a lactation masseur clear any residual milk can be effective. However, if symptoms like high fever and chills occur, along with localized redness and swelling, it is advised to go to the hospital to have a complete blood count and an ultrasound. If the leukocyte count is under 10,000 and there is localized swelling, topical application of Rifanuo and oral anti-inflammatory medication can be curative, but it is necessary to stop breastfeeding. If the leukocyte count exceeds 10,000, intravenous antibiotics may be required, alongside cessation of breastfeeding. Then, using a breast pump to extract the milk can help in healing. (Please use medications under the guidance of a doctor.)

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Treatment methods for acute mastitis

The treatment methods for acute mastitis start with stopping breastfeeding. For those with mild symptoms or less severe conditions, breastfeeding can continue, but it is not advisable to breastfeed from the affected breast. Instead, a breast pump can be used to express the milk. Secondly, the breast can be supported with a bra. Thirdly, for local redness and swelling, hot compresses can be applied, or ichthyol ointment can be used topically, as well as Levonorgestrel topical application. If blood tests show elevated levels, systemic antibiotics should be used, with the choice of penicillins and cephalosporins for symptomatic treatment. If an ultrasound shows an abscess formation, it is recommended to perform an abscess incision and drainage procedure, or, if it's deeper, a thick needle can be used for aspiration to draw out the abscess.

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Can I eat eggs with acute mastitis?

Patients with acute mastitis can eat eggs, but should not consume them in excess, as too many can lead to increased accumulation of body fat and elevated cholesterol levels. Prevention is more important than treatment for mastitis, and specific methods include maintaining nipple cleanliness during lactation. Frequently wash with warm, soapy water, and nipples can also be washed with 3% boric acid water before and after breastfeeding. For those with inverted nipples, gently squeeze out the nipple before washing. It is important to develop good breastfeeding habits, breastfeed on a schedule, and ensure that all the milk is drawn out each time. If the milk cannot be fully expressed, use hand massage or a breast pump. Additionally, do not let the baby suckle while sleeping. If there is nipple damage or cracking, stop breastfeeding, use a breast pump to extract milk, and resume breastfeeding once the wound has healed.

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Is hot compress effective for acute mastitis?

An important factor in acute mastitis is the accumulation of milk during breastfeeding, which leads to mastitis. Applying heat can be somewhat effective, as it helps to unblock the milk, thus further alleviating and controlling the symptoms of mastitis. However, heat application is mainly used in the initial stage of mastitis. If the condition progresses further, with more apparent systemic symptoms or pus formation, then heat application is not very effective. Further anti-infection treatment and, if necessary, incision and drainage surgery are needed to control the condition.