Mastitis

The breast is composed of lobules, where milk is produced, and milk ducts, which transport this milk to the nipple. These structures are surrounded by fatty and connective tissue, as well as a dense vascular and lymphatic network. During breastfeeding, inadequate emptying of the milk ducts can cause milk to stagnate, promoting local inflammation.

Mastitis occurs when this inflammation spreads and causes tissue swelling, further compressing the milk ducts and aggravating milk retention.

The symptoms of mastitis can appear suddenly and worsen if not treated quickly. The clinical presentation varies depending on the type of mastitis.

Symptoms of lactational mastitis

Patients generally present with:

• A well-defined, painful redness on one breast.
• A feeling of local heat.
• Persistent pain, often accompanied by a burning sensation during breastfeeding.
• A fever above 38°C and chills.
• A general feeling of malaise with fatigue and body aches.

These signs are characteristic of an underlying bacterial infection. If the inflammation progresses, a breast abscess may form, requiring surgical drainage.

Symptoms of non-lactational mastitis

In mastitis not related to breastfeeding, symptoms vary depending on the underlying cause:

• Periductal mastitis: manifests as an inflammatory mass under the areola, sometimes associated with purulent nipple discharge and an inverted nipple.
• Idiopathic granulomatous mastitis: can mimic breast cancer, with the presence of a hard mass, nipple retraction, and “orange peel” skin inflammation.

In all cases, if symptoms persist for more than 48 hours despite symptomatic treatment, medical consultation is necessary to avoid complications.

Mastitis usually results from a combination of factors that promote inflammation and infection in the breast. Its causes differ depending on whether it occurs in a breastfeeding woman or not.

Causes of lactational mastitis

In women who are breastfeeding, mastitis is often caused by milk stagnating in the milk ducts, which creates a favorable environment for bacterial growth. This phenomenon can be caused by:

• A blocked milk duct, preventing milk from being completely evacuated.
• A bacterial infection, usually Staphylococcus aureus, which can enter through cracks in the nipple.
• Insufficient milk flow due to irregular breastfeeding or ineffective suckling by the infant.

Causes of non-lactational mastitis

In women who are not breastfeeding, mastitis can have various causes:

• Periductal mastitis, the exact cause of which remains unknown but is strongly associated with smoking, leading to inflammation of the subareolar milk ducts.
• Idiopathic granulomatous mastitis (IGM), a rare inflammatory disease that may be related to an abnormal immune response or bacterial infection.

Certain conditions promote the onset of mastitis by disrupting milk flow or weakening breast tissue. In breastfeeding women, a history of mastitis, nipple damage, or ineffective suckling by the infant increase the risk of inflammation and infection. Incomplete emptying of the breast, irregular breastfeeding, or abrupt weaning also promote milk stagnation, creating a breeding ground for bacterial growth.
Factors related to the mother's general health, such as fatigue, stress, or an unbalanced diet, can weaken the immune system and make the body more vulnerable to infection.
Outside of breastfeeding, mastitis can be promoted by smoking, which causes chronic inflammation of the milk ducts, increasing the risk of abscesses. Obesity and diabetes are also suspected of playing a role, due to their impact on blood circulation and immune response.

The diagnosis of mastitis is based primarily on clinical examination, but additional tests may be necessary in cases of doubt.

Clinical examination

Mastitis is often identified by visible signs:

• A red, painful, and swollen area on one breast.
• A fever above 38°C associated with flu-like symptoms.
• Localized hardening, sometimes accompanied by purulent discharge from the nipple.

Additional tests

Additional tests may be required in some cases:

• Breast ultrasound, indicated if a lump or abscess is suspected.
• A breast milk culture, recommended in cases of severe or recurrent mastitis to identify the pathogen.
• Fine needle aspiration, used if an abscess is suspected to confirm the presence of pus and determine the bacteria responsible.
• Breast biopsy, performed when mastitis does not respond to standard treatment to rule out an underlying condition such as inflammatory breast cancer.

The treatment of mastitis depends on its cause and the severity of the symptoms. For mild to moderate cases, symptomatic treatment is usually sufficient. This involves continuing to breastfeed or regularly expressing milk using a breast pump, staying well hydrated, and taking anti-inflammatory medication to relieve the pain. Applying warm compresses before feedings facilitates milk drainage, while cold compresses after breastfeeding can reduce inflammation and pain.

If symptoms persist or intensify after 24 to 48 hours, medication may be necessary. Antibiotics are usually prescribed to treat a possible bacterial infection. If there is an insufficient response to the initial treatment, an adjustment may be considered in order to more precisely target the bacteria responsible.

When mastitis progresses to an abscess, drainage is sometimes required. This procedure, performed under ultrasound guidance, allows the pus to be drained and the inflammation to be relieved. In the most severe cases, surgical treatment may be considered.

When treated promptly, mastitis usually heals without leaving any lasting effects. However, if the inflammation is not treated, it can worsen and lead to complications. The formation of an abscess is one of the most common developments. It manifests as a painful, fluctuating mass that requires drainage.
In some patients, mastitis can recur, especially if the contributing factors are not corrected. Prolonged or poorly treated inflammation can also lead to breast fistulas, which require surgery.
It is also important to differentiate between persistent mastitis and inflammatory breast cancer. If symptoms do not improve despite appropriate treatment, additional tests such as a biopsy should be performed to rule out any other conditions.

Preventing mastitis primarily involves proper breastfeeding management. It is recommended to breastfeed regularly and ensure that the breast is fully drained after each feeding. Correct positioning of the infant and proper latching also reduce the risk of engorgement and cracked nipples, which can be a gateway for infections.
It is advisable to avoid tight clothing that could compress the breasts and hinder milk flow.
Non-breastfeeding women can also take certain precautions to limit the risk of mastitis. Quitting smoking is strongly recommended, as it reduces inflammation of the milk ducts and lowers the risk of complications. A balanced diet and good hydration help maintain an effective immune system and prevent infections.

If breast pain persists beyond 24 to 48 hours despite regular milk expression and symptomatic treatment, medical consultation is necessary. The onset of high fever, chills, or general malaise may indicate an infection requiring appropriate treatment.
A red, hot breast that does not improve despite taking antibiotics should also be evaluated. The presence of a persistent or fluctuating lump may indicate a breast abscess, which will require drainage. Finally, mastitis that does not heal after several treatments should be investigated further to rule out an underlying condition.

Hôpital de La Tour offers comprehensive care for patients suffering from mastitis, whether or not it is related to breastfeeding. Thanks to a team specializing in gynecology and breast cancer/breast center, patients receive appropriate medical support, including accurate diagnosis and personalized treatment.
For breastfeeding mothers, Hôpital de La Tour provides lactation consultants who are trained to help patients. Breastfeeding support workshops are also offered to optimize breastfeeding and provide practical solutions to prevent engorgement and nipple cracks.
In cases of mastitis requiring further monitoring, imaging tests such as breast ultrasound are used to assess the presence of an abscess. If drainage is required, it is performed under ultrasound guidance for a quick and minimally invasive procedure.

Can mastitis heal without treatment?
In some cases, measures such as frequent breastfeeding and applying warm compresses are enough to resolve the inflammation. However, if symptoms persist for more than 24 to 48 hours, medical attention is recommended.
 

Should I stop breastfeeding if I have mastitis?
No, on the contrary, it is best to continue breastfeeding or pumping milk to prevent the inflammation from worsening.
 

How can I recognize a breast abscess?
An abscess manifests as a painful, fluctuating lump in the breast, sometimes accompanied by redness and persistent fever. An ultrasound scan can confirm the diagnosis.
 

What are the first signs of mastitis?
Symptoms include localized pain, redness of the breast, a feeling of warmth, and sometimes flu-like symptoms such as chills and intense fatigue.
 

How can recurrence of mastitis be prevented?
Proper breast drainage, regular breastfeeding, and support from a lactation consultant can reduce the risk of recurrence.
 

Can mastitis affect women who are not breastfeeding?
Yes, although it is rarer, non-lactational mastitis can occur, particularly in connection with smoking or certain inflammatory conditions.
 

What are the main risk factors?
Nipple cracks, untreated engorgement, smoking, and certain underlying diseases such as diabetes can increase the risk of mastitis.