Puerperal Mastitis and Breast Engorgement

Mastitis and breast engorgement are often the result of an incorrect breastfeeding technique; the consequences can be severe if you do not promptly take the necessary measures.

Breast engorgement is not rare during breastfeeding particularly at early stages and is linked to a  milk breastfeedingemptying problem because of anatomical conditions (maternal or of the newborn) or poor feed technique. It is recognizable because milk accumulates in the secretory ducts and sinuses appear swollen, tender and warmer than normal. This condition sometimes regress spontaneously, but if not treated properly evolves up to mastitis. 

For its management I recommend to contact midwives or lactation consultants choosed by the hospital. Do not waste time, because small precautions can easily overcome this delicate moment common to many women.

Puerperal mastitis is one of the major breastfeeding complication and there is a really thin line between it and breast engorgement. Characterized by pain, swelling, inflammation and warmth of the affected part is often unilateral and is favored by gland inadequate emptying. It is determined by milk contamination mainly of staphylococci, beta-hemolytic streptococci, Gram-negative bacteria, and sometimes fungi (Candida).

It predominantly affects primiparous and so women at the first breastfeeding experience, but can also occur in women with more children. Frequently occurs in the first 10 days after birth. In light forms has a limited extension, and may be associated with mild fever, while in more severe forms can come to involve the entire gland (parenchymatous mastitis and interstitial mastitis) and determine high fever, vascular and lymphatic congestion (particularly evident at subcutaneous level) with enlarged underarm lymph nodes.

The evolution of non treated forms which don’t have a spontaneous regression is the abscess. About  possible negative implications on newborn feeding and complications that this disease can bring, it requires the utmost attention, and the diagnosis should be made early and an adeguate therapy should be started as soon as possible.

Mastitis management is a medical competence, so always refer to a trusted doctor. Medical therapy is mainly based on the use of antibiotics and anti-inflammatory drugs. It is not always possible to obtain in time a mammary secretions bacteriological examination with antibiogram, but I personally recommend it. Identification of infectious causes could be useful after a  failure of the first line of treatment.

It is not always necessary to stop breast-feeding, and a possible suspension will be assessed by the physician on the basis of the medicines used and on the patient clinical situation.

When an abscess is present, this will necessarily sliced and drained.

Some advices for Mastitis affected patients:

– breast must be emptied regularly, and if you have been advised to temporarily suspend breast-feeding, use a breast pump;

– use a sturdy but comfortable bra;

– inflamed and hot areas must be cooled with cold packs;

– rest properly.

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Filiberto Di Prospero
Medical Doctor, Consultant in Gynecology and Obstetrics, Endocrinology and Metabolism. Director of Gynecologic Endocrinology Unit at Civitanova Marche General Hospital (Italy). Private clinics in Civitanova Marche, Rome and Milan.

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