Mastitis

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Mastitis

Mastitis is an inflammation of the breast. Dominant age

    • Mastitis of newborns occurs in the first days of life as a result of infection of hyperplastic glandular elements.
    • Postpartum mastitis – during breastfeeding
    • Periductal mastitis (plasmocytic) – more often during menopause.

Predominant sex

    • Mostly women are affected
    • Juvenile mastitis – in adolescents of both sexes during puberty.

Classification

    • With the flow
    • Acute: serous, purulent (phlegmonous, gangrenous, abscessing: subareolar, intramammary, retromammary)
    • Chronic: purulent, non-purulent
    • By localization – intracanalicular (galactophoritis), periductal (plasmocytic), infiltrative, spilled. Etiology
    • Lactational (see Breastfeeding)
    • carcinomatous
    • Bacterial (streptococci, staphylococci, pneumococci, gonococci, not often combined with other coccal flora, Escherichia coli, Proteus).

Risk factors

    • Lactation period: violation of the outflow of milk through the milk ducts, cracks in the nipples and within the nipple field, improper care of the nipples, violations of personal hygiene
    • Purulent diseases of the breast skin
    • Mammary cancer
    • Diabetes
    • Rheumatoid arthritis
    • Silicone/paraffin breast implants
    • Taking glucocorticoids
    • Removal of a breast tumor followed by radiotherapy
    • Long history of smoking.

Pathomorphology

    • Squamous metaplasia of the epithelium of the ducts of the mammary glands
    • Intraductal epithelial hyperplasia
    • Fat necrosis
    • Expansion of the ducts of the mammary glands.

Clinical picture

    • Acute serous mastitis (may progress with the development of purulent mastitis)
    • sudden onset
    • Fever (up to 39-40 ° C)
    • Severe pain in the breast
    • The gland is enlarged in volume, tense, the skin over the focus is hyperemic, on palpation – a painful infiltrate with fuzzy boundaries
    • Lymphangitis, regional lymphadenitis.
    • Acute purulent phlegmonous mastitis
    • Severe general condition, fever
    • The mammary gland is sharply enlarged, painful, pasty, the infiltrate without sharp boundaries occupies almost the entire gland, the skin over the infiltrate is hyperemic, has a bluish tint
    • Lymphangitis.
    • Acute purulent abscess mastitis
    • Fever, chills
    • Pain in the gland
    • Mammary gland: redness of the skin over the lesion, retraction of the nipple and skin of the mammary gland, sharp pain on palpation, softening of the infiltrate with the formation of an abscess
    • Regional lymphadenitis.

Laboratory research

    • Leukocytosis, increased ESR
    • A bacteriological study is required to determine the sensitivity of microorganisms to antibiotics. Special Studies
    • ultrasound
    • Mammography (unbelievable to completely rule out breast cancer)
    • Thermal Imaging Research
    • Biopsy of the breast.

Differential Diagnosis

    • Carcinoma (inflammatory stage)
    • Infiltrative breast cancer
    • Tuberculosis (may be associated with HIV infection)
    • Actinomycosis
    • Sarcoid
    • Syphilis
    • Hydatid cyst
    • Sebaceous cyst.

Treatment:

Conservative therapy

    • Isolation of mother and child from other mothers and newborns
    • Stopping breastfeeding with the development of purulent mastitis
    • Bandage that suspends the mammary gland
    • Dry heat on the affected mammary gland
    • Expression of milk from the affected gland in order to reduce its engorgement
    • If pumping is unbelievable, bromocriptine 0.005 g 2 r / day for 4-8 days is prescribed to inhibit lactation
    • Antimicrobial therapy: erythromycin 250-500 mg 4 r / day, cephalexin 500 mg 2 r / day, cefaclor 250 mg 3 r / day, amoxicillin-clavulanate (Augmentin) 250 mg 3 r / day, clindamycin 300 mg 3 r / day (if anaerobic microflora is suspected)
    • NSAIDs
    • Retromammary novocaine blockade. Surgery
    • Aspiration of contents under ultrasound guidance
    • Opening and drainage of the abscess with careful separation of all ligaments
    • Operational incisions
    • With subareolar abscess – along the edge within the nipple field
    • Intramammary abscess – radial
    • Retromammary – along the submammary fold
    • With small volumes of the abscess, it is likely to be excised with adjacent inflammatory tissues according to the type of sectoral resection with active drainage of the wound with a 2-lumen tube and suturing tightly
    • Opening of all fistulous passages
    • With the progression of the process – removal of the gland (mastectomy).

Complications

    • Fistula formation
    • Sepsis
    • Subpectoral phlegmon.

The course and prognosis are favorable

    • Full recovery begins within 8-10 days with adequate drainage
    • After operations, scars remain, disfiguring and deforming the mammary gland.

Prevention

    • Careful breast care
    • Compliance with feeding hygiene
    • Use of emollient creams
    • Expression of milk.

Synonym. Mastitis

See also Breastfeeding

ICD. N61 Inflammatory diseases of the breast