Mastitis, the difference between puerperal and non-puerperal

By Cristiano Antonino Last updated Jun 2, 2023

Mastitis is a very frequent inflammatory pathology after childbirth, during breastfeeding, and is usually due to an infection of bacterial origin

This condition alters the appearance and functionality of the breasts causing many inconveniences.

In the case of breastfeeding women, it is puerperal mastitis, an inflammation that concerns the mammary ducts, the channels that favor the passage of mother’s milk towards the outside of the breast, through the nipple.

It tends to be unilateral, affecting one breast at a time.

Acute mastitis can also arise for reasons independent of breastfeeding: in this case we speak of acute non-puerperal mastitis.

Acute mastitis causes pain and fever, but it must not limit breastfeeding, on the contrary: it has been demonstrated that women must continue to breastfeed even if affected by mastitis to favor breast drainage and to reduce the risk of infection spread in contiguous areas.

Puerperal mastitis usually occurs during the first six weeks after delivery (but it can also occur later, albeit more rarely).

The World Health Organization estimates that the incidence of mastitis is between 2.6% and 30%, occurring in 80% of cases between the ages of 20 and 40 and affecting up to 10% of women who breastfeeding (source: Mastitis – Causes and Management).

We are therefore talking about a frequent pathology especially in breastfeeding women and which must be treated in time to avoid complications.

Symptoms of mastitis

The symptoms of mastitis are quite clear and can scare new mothers: an area of the breast becomes very sensitive, hot, painful; this symptomatology is generally accompanied by fever (around 38.5 °C but even higher).

It might look like the flu, but if redness, pain and warmth are evident in the breasts, then it means that the milk draining to the nipple is engorged or blocked.

This engorgement, if not treated properly, can lead to infectious mastitis and breast abscess.

Mastitis can get worse within hours and should therefore be treated immediately.

The skin, due to inflammation, is particularly tense, and also causes a burning and discomfort sensation in the mother.

In general, this pathology causes a feeling of general malaise, as happens with flu syndromes, accompanied by a feeling of weakness and loss of appetite, but the main disturbance is concentrated in the breasts and breasts.

Causes of mastitis

Mastitis occurs due to insufficient drainage of the breast and milk stasis, resulting in inflammation.

This insufficient drainage can therefore have two causes, of a mechanical or infectious nature.

In the first case, mastitis can be caused by incorrect attachment of the baby to the mother’s breast during breastfeeding (it attaches only to a portion of the nipple) which can in turn cause skin lesions or fissures, thus favoring a state of inflammation.

A second very common cause is breast engorgement, i.e. the obstruction of a lactiferous duct which results in a stagnation of milk that favors the growth of microorganisms.

An abnormal drainage due to infectious causes can also occur due to a lowering of the woman’s immune defenses, which, being weaker, is more predisposed to infection by pathogens such as staphylococci, the bacteria most involved.

These microorganisms, in fact, are normally found on the skin and can penetrate through small wounds at the level of the breast (as happens with fissures) developing the infectious process.

Other factors that may favor the onset of mastitis are long intervals between feeds/infrequent feeds (midwives advise not to look at the clock, rather understand the baby’s requests), wearing clothing that is too tight around the breast, excessive production of milk and weaning too fast and premature.

Diagnosis

It is possible to diagnose mastitis by requesting a specialist visit, during which the doctor, midwife or professional in general, through an objective examination, analyzes the state of the breast and the symptoms highlighted by the patient, generally sufficient to identify mastitis.

It is important to intervene with prompt therapy to prevent mastitis from becoming complicated with other types of disorders.

Only rarely are laboratory and instrumental tests necessary, such as:

Breast ultrasound or mammography, to diagnose an abscess or rule out breast cancer.
Milk culture test: in the event of repeated episodes of mastitis, it allows you to accurately determine which infectious agent is responsible for intervening with a specific and correct antibiotic therapy.
Laboratory tests or other diagnostic procedures are required only if the mastitis is not responsive to treatment; if it relapses; if it is contracted in hospital; if the woman reports allergies to normal antibiotics.
A differential diagnosis is required if the mastitis does not go away within 12 hours and even gets worse

If so, your doctor may do tests to detect or rule out:

inflammatory breast cancer (a serious form of cancer that presents with the typical symptoms of mastitis);
Mondor’s disease (inflammation of veins under the skin of the chest wall, usually secondary to local trauma);
mastodynia (cyclic breast pain in the absence of infection that increases in the premenstrual period).

The most critical period for the onset of mastitis are the first weeks of breastfeeding

The mother must be familiar with how the baby attaches to the breast to avoid complications.

Risk factors that increase the chances of incurring this inflammation are:

incorrect attachment to the nipple by the newborn, which grasps only a part of the nipple and not the entire areola;
repeated and exclusive use of the same breast for several consecutive feeds, leaving the other breast engorged;
injuries such as fissures, caused by the baby latching on to the nipple incorrectly, and small wounds to the nipple, including those due to the use of piercings;
use of bra or clothing that is too restrictive on the chest;
diabetes and other chronic diseases that weaken the immune system.

If neglected, mastitis can evolve into more serious complications such as an abscess, or a collection of pus in the mammary gland.

In these cases it becomes necessary to proceed with a surgical treatment or with ultrasound-guided fine needle aspiration (in the case of a modest sized abscess) or through a surgical incision with drainage (in the case of a larger abscess).

Therapies

The first thing a mother can do at the first signs of mastitis is to continue breastfeeding the baby starting with the affected breast and very frequently to facilitate the elimination of blockages and traffic jams.

If pain interferes (as often happens) with the breastfeeding process, mothers can instead start breastfeeding from the healthy breast, moving on to the sore one a little at a time or they can help themselves with a breast pump and then proceed with manual emptying (even under the shower).

Furthermore, it is necessary to support positioning and attachment to the breast, trying different breastfeeding positions, also using a pillow to support the baby (feeding pillows are particular models designed specifically to help breastfeeding mothers), in an attempt to eliminate any blockage.

Rest is very important, just as it is advisable to apply hot compresses before feeding to stimulate the flow of milk and cool it down with cold compresses after feeding to soothe pain and inflammation (cold has an anti-inflammatory effect).

The doctor may suggest the use of pain relievers to relieve pain and promote milk flow, an anti-inflammatory such as ibuprofen, for example.

If the fever rises or the symptoms have not improved within 12/24 hours, antibiotics are usually recommended for the treatment of mastitis but one that is effective and compatible with breastfeeding is needed (it should only be taken on prescription).

Finally, if the symptoms of mastitis do not disappear within a few days, then it is advisable to seek medical advice for a broader differential diagnosis which could confirm the presence of resistant bacteria, abscess formation or the other breast problems described above.

Prevention

Mastitis is absolutely preventable with correct breastfeeding practices, therefore with the right training of the mother in the pre-natal phase.

After birth, the mother must ensure that the baby attaches correctly to the breast during breastfeeding, that the breast is completely emptied before offering the other and that the breasts are alternated at each feed, following breastfeeding on demand from part of the child.

During breastfeeding it is important that the mother is hydrated by drinking often and that her diet is healthy and balanced.

In fact, let’s not forget that many of the small ailments of the breastfed child are related to the mother’s dietary errors.

As a preventive measure, the mother must practice correct breast hygiene during pregnancy and breastfeeding, wash the breast before and after each feed 3-4 times a day with warm water and a delicate soap, drying the area carefully, breastfeed if possible until natural weaning and beyond and avoid bras and clothing that are too constrictive for the breast, in favor of comfortable bras made of cotton, which let the breasts breathe.

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