Treatment of mastitis - surgery and medicinal methods

Causes of mastitis in women

Mastitis, which develops in lactating women, is several times more common than non-lactation mastitis. The main cause and provoking factor is a violation of the outflow of milk. When lactostasis forms, a site is formed in the mammary gland where optimal conditions are created for the proliferation of pathogenic microflora.

The main types of microorganisms that cause mastitis in women are staphylococci, streptococci, and less commonly, Escherichia coli, Proteus, enterococci and other opportunistic microbes. They penetrate the milk ducts from the skin and areola of the breast. Nipple cracks often become the entry point.

The infection can be on the skin of a young mother or penetrate into the wound from hands that were poorly treated before feeding. There are practically no cases of the pathogen entering the breast ducts in any other way. But experts do not exclude an increased risk of mastitis in chronic foci of infection in the form of pyelonephritis, tonsillitis or caries.

Mastitis in non-breastfeeding women

Mastitis rarely occurs in women outside the lactation period. In this case, it is most often associated with trauma to the mammary gland. Sometimes inflammation occurs when a breast tumor or cyst suppurates. But this is also usually preceded by injury or another cause, which makes it easier for infection to enter.

For non-lactation mastitis

the disease begins with pain in the mammary gland, an increase in body temperature to low-grade levels. Soon a painful compaction (infiltrate) appears in the gland with redness above it. Non-lactation mastitis must be differentiated from inflammation and suppuration in the mammary gland cyst; this can be done by ultrasound. A differential diagnosis should also be made with an abscessing boil in the breast area. An abscess boil is distinguished by its superficial location, as well as the presence of a purulent-necrotic core in the center of the infiltrate.

Symptoms of mastitis in women

Mastitis, which develops in lactating women, is a complication of milk stagnation. Pathology most often occurs in the first month after the birth of a child. For the formation of lactostasis, it is necessary that milk accumulates in one or more lobes of the mammary gland, and the excretory duct is blocked. This condition occurs under the influence of the following factors:

underwear that is too thick;
improper attachment of the baby to the breast;
nipple cracks;
disturbance of the rhythm of feeding;
hormonal causes – oxytocin deficiency;
very large breasts;
hypothermia of the mammary gland;
injury.

Women who had mastopathy before pregnancy are more likely to encounter mastitis. At the same time, connective tissue grows in the chest, which deforms or blocks the ducts.

At first, the woman feels pain, a feeling of fullness in the chest. Usually on one side. The general condition does not suffer with lactostasis. If the disease enters the mastitis phase, body temperature rises, headache, weakness, nausea occur and appetite worsens. Then a clear focus appears with pronounced redness and tension of the skin, dense to the touch, with a doughy consistency.

Lactation mastitis

usually begins with lactostasis - characterized by high body temperature with a relatively satisfactory general condition, the presence of a painful compaction in the gland tissue, slight redness of the skin over the compaction. If lactostasis is not resolved within 3-5 days, it turns into purulent mastitis, because Inevitable infection of the stagnant milk occurs through the milk ducts.

The temperature becomes normal in the morning, and in the evening it rises to 37.5 - 37.8 degrees. The compaction in the gland increases, becomes more painful, and the redness over it increases. Inflammation of regional lymph nodes in the axillary region is possible. Ultrasound helps clarify the diagnosis.

Treatment of mastitis in women

If a woman has problems with the outflow of milk, it is necessary to try to express it as soon as possible and eliminate the manifestations of lactostasis. If independent measures are ineffective, the help of a mammologist will be required.

Treatment of mastitis in women depends on the stage at which she consulted a doctor. The sooner this is done, the easier and safer the treatment will be.

Drug therapy for mastitis

Drug treatment of mastitis in women is allowed on the first day after the onset of the disease. At this stage, according to the examination results, an abscess with clear edges should not form. This phase is called infiltrative. There is an inflamed lesion, but so far it does not have a cavity with pus.

Broad-spectrum antibiotics are used to treat mastitis. Milk must be expressed to maintain lactation. This will make it easier to restore it after recovery.

When treating mastitis in women, medical supervision is necessary. Otherwise, the condition may quickly worsen. Additionally, for detoxification, droppers with saline, glucose, and Ringer's solution are prescribed. They accelerate the elimination of toxic metabolic products of bacteria. Drug therapy for mastitis is acceptable during the first 24 hours. If a woman’s condition worsens due to the use of antibiotics, an abscess forms in the chest, they move on to more active tactics.

Surgery for purulent mastitis in women

To completely eliminate purulent mastitis, surgical treatment is necessary. It is carried out under anesthesia. The purpose of the operation is to open the abscess, clean the wound and prevent the re-development of inflammation.

The doctor makes a neat incision on the mammary gland, removes pus, and washes the wound with an antiseptic solution. Drainage tubes are inserted into the wound to drain interstitial fluid. The entire operation takes about 30-40 minutes.

After surgery, detoxification drips and antibiotics are prescribed to prevent infectious complications. The duration of treatment is individual and depends on the patient’s condition.

After treatment of mastitis, you can continue breastfeeding your baby. The doctor will give recommendations on how to effectively restore lactation and what regimen to follow.

If you have symptoms of mastitis, make an appointment with our Surgery Center by calling the number listed on the website or using the feedback form.

Question to the doctor: how to avoid chronic mastitis

According to the observations of specialists, non-lactation mastitis has recently become more common. As is clear from the name, this condition is not associated with breastfeeding (lactation mastitis requires a separate discussion). Why does acute mastitis occur? For what reasons does it become chronic purulent? Can this be avoided? And what approach to the treatment of acute and chronic mastitis is adopted at the Vishnevsky Surgery Center?

About this - Candidate of Medical Sciences, surgeon, mammologist-oncologist of the surgical thoracic department of the National Medical Research Center of Surgery named after. A.V. Vishnevsky Natalya Yurievna Germanovich.

Why does non-lactation mastitis occur?

Non-lactation mastitis is an inflammatory process in the mammary gland. What can trigger it? There are many factors. Hormonal imbalance, mechanical trauma, fibrocystic disease (breast cysts), cracked nipples, infectious disease (pathogens in 90% of cases are staphylococci, streptococci), chronic infection (on the skin, in the oral cavity and nasopharynx, in the urogenital system).

Often the cause lies in carious teeth, and after sanitation of the oral cavity the problem is resolved. This surprises patients (“teeth and breasts - what’s the connection?”), but there is nothing surprising here. You need to understand that through the blood and lymphatic channels, an infection - from any zone - can spread throughout the body. This is especially true when the immune system is weakened, when the mammary glands become the target organ for infection.

In fact, every woman aged 20 to 45 is at risk.

Why can acute mastitis become chronic?

Chronic mastitis often develops due to late consultation with a doctor and/or becomes a consequence of long-term, incorrect treatment of acute mastitis.

Chronic mastitis is characterized by the formation of fibrous capsules and scar connective tissue, with their help the body isolates the focus of purulent inflammation from healthy tissue. This lesion can be located in any area of the mammary gland under the skin, in the area of the areola (subareolar), in the lobules of the mammary gland (intramammary), between the mammary gland and the pectoral muscle (retromammary).

How do we treat chronic purulent mastitis?

We are convinced that the modern approach to the treatment of chronic mastitis should consist (if we do not go into medical nuances) of two key points.

First. It is absolutely not enough to open and drain the main purulent focus. The insidiousness of chronic mastitis is that small pustules (sequestra) “break off” from the main focus and disperse throughout the tissues of the mammary gland, and there can be quite a lot of them. During surgery, it is fundamentally important to find and eliminate all sequestration. If this is not done, the inflammatory process will continue, and the patient will have to be operated on again and again. There are cases when the number of operations for chronic mastitis reached 20!

Our principle is radical resection, which would eliminate the risk of development and recurrence of the disease.

We must also take into account that the appearance of the breasts is extremely important for any woman (even older ones, not to mention very young girls). Therefore, when performing an operation, we do not forget about the aesthetic side of the issue and make incisions - depending on the specific clinical situation - so that subsequently the signs of surgical intervention are not noticeable.

Another key point of the modern integrated approach to the treatment of chronic mastitis is as follows. We believe that the second stage must necessarily be the use of modern rehabilitation methods, including vacuum therapy. In our experience, this improves healing, speeds recovery and minimizes the risk of relapse.

The stories of two patients that I want to tell are clear examples of how important it is to promptly and radically treat acute mastitis so that the situation does not worsen even more and it does not become chronic.

Story one. Patient 37 years old

Complaints: pain in the area of the right breast, increased body temperature to 39-39.7, severe weakness and fatigue. The doctor at the local clinic suspected mastitis.

Ultrasound of the mammary glands indicated a local purulent process in the area of the upper outer quadrant up to 1.5 x 1.7 cm. (The mammary gland is conventionally divided into four quadrants - this makes it possible to more accurately indicate the localization of the pathological focus.) Antibacterial and anti-inflammatory therapy was prescribed.

At first, everything went well: the patient felt better, her body temperature dropped to low-grade fever, and the swelling decreased. But two weeks passed, and she went to the clinic again.

Ultrasound showed swelling of the skin of the right breast, para-areolar (in the area of the areola) - a purulent focus up to 1.5 cm in size with signs of abscess formation.

This time, the doctor referred the patient to a surgeon, who opened and drained the abscess.

Unfortunately, this intervention did not solve the problem, because a month later the patient began to notice pain in the right mammary gland, swelling and an increase in body temperature to 38-39. She was once again prescribed antibacterial therapy, which again gave a temporary effect. Six months later, the patient was admitted to our Center not only with complaints of enlargement of the right breast, swelling and temperature, but also a fistula in the area of the postoperative scar with purulent discharge, as well as severe weakness.

We examined: the mammary glands are asymmetric due to the enlargement of the right one, the skin is swollen, in the area of the upper outer quadrant it has a dark purple color, compacted in the area of the upper outer and lower outer quadrants with areas of softening, in the area of the postoperative scar there is a fistula with purulent detachable.

Ultrasound of the mammary glands revealed a diffuse retromammary abscess, multiple sequesters in the area of the upper-outer and lower-outer quadrants, an abscess in the area of the upper-outer quadrant 5x6 cm. After a biopsy of this abscess, purulent contents in a volume of 50 ml were obtained, and the material was sent for cytological examination and bacterial culture, taking into account a long history of chronic infection (6 months).

Diagnosis: chronic non-lactation purulent retromammary gangrenous mastitis on the right.

This case shows how aggressive purulent mastitis can behave without timely radical treatment. Due to the long course of the disease and the large volume of tissue that had undergone purulent fusion, we were forced to excise a significant part of the mammary gland (subtotal resection was performed).

At the same time, we could not ignore the aesthetic side of the issue and made incisions along the submammary fold (under the breast) and paraareolar (in the areola area), so that after healing the scars would be practically invisible.

In the postoperative period, dressings were performed every other day, and modern rehabilitation methods were prescribed. Despite the extensive purulent process and the duration of its course, it was possible to achieve a satisfactory cosmetic effect.

The second story. Patient 46 years old

Complaints: pain in the left mammary gland, lumpiness, skin hyperemia (redness) in the area of the boundaries of the outer quadrants, increased body temperature to 37.5, light gray discharge from the nipples. Mammography revealed a focal formation up to 3 cm, located on the border of the outer quadrants, without clear boundaries. Ultrasound of the mammary glands - a formation up to 2.7 x 3.5 x 2.5 cm in the area of the boundaries of the outer quadrants with fairly clear boundaries. A smear from the left nipple showed a picture characteristic of fibrocystic mastopathy.

Mastitis was suspected and antibacterial therapy was prescribed. The positive effect it provided was only temporary, and when it became clear that surgical treatment could not be avoided, the patient contacted us at the Center.

A series of examinations was carried out and a diagnosis was made: chronic purulent non-lactational abscessing intramammary mastitis on the left (subsequent histological examination confirmed it).

Since the purulent process by this time had already spread over a large area, and the inflammatory process was long-standing, we performed a wide resection of the mammary gland. During the operation, multiple sequestra with purulent contents were discovered and removed.

After surgery, the patient also underwent a course of rehabilitation procedures.

I would like to repeat once again: chronic purulent mastitis becomes a consequence of untimely radical treatment of acute mastitis, and this is very important to understand for both doctors and patients.

What should you do if you suspect you have mastitis?

Due to the pandemic, patients are postponing visits to the mammologist, which should not be done. There can be only one recommendation: observing all epidemiological safety measures - see a doctor immediately!

Recommendations

Breast mastitis requires immediate action and adequate treatment. To achieve a speedy recovery and not harm your health, you need to adhere to the following recommendations:

Treatment of mastitis should be trusted only to qualified specialists. Independent actions can lead to negative consequences and the transition of the disease to a more complex stage.
To achieve effective results, you cannot ignore the recommendations of your doctor.
When identifying the first signs of mastitis, you need to refrain from thermal procedures and regularly express milk.

Only professional treatment of mastitis will help get rid of the inflammatory process and avoid its reappearance.

Mechanism of disease development

Pathogenic microorganisms enter the woman’s mammary gland through blood or microcracks in the nipples. After this, the pathogens begin to actively multiply and secrete waste products that have a detrimental effect on the human body. As a result, the first symptoms of mastitis appear in the form of fever and general malaise.

The immune system responds to the inflammatory process by producing white blood cells designed to suppress the source of infection. This is accompanied by dilation of blood vessels and the appearance of characteristic signs of mastitis.

What are the different forms of mastitis?

There are several classifications; when making a diagnosis, the doctor identifies the type of pathology depending on the conditions of its occurrence. This gradation includes two forms of mastitis:

Non-lactational – rare and not associated with breastfeeding. Usually it is predisposed to injury, hypothermia, and infection entering the gland through the blood or lymph.
Lactation - most diseases are represented by this form. It develops after childbirth, is acute and requires immediate treatment.

The doctor indicates the type of mastitis in the medical history. This classification is paid attention to when prescribing therapy. If a non-lactational form is diagnosed, testing may be expanded to look for the cause.

According to the clinic, several types of mastitis are distinguished:

infiltrative - when swelling of local tissues is noted, compactions appear;
serous - with this form, fluid accumulates in the intercellular space, symptoms are moderate;
abscess – characterized by limited purulent inflammation;
phlegmonous – a diffuse purulent area is observed;
gangrenous – accompanied by the death of glandular tissue;
chronic infiltrative mastitis - accompanied only by local symptoms.

There is also a classification according to the prevalence of pathological changes - mastitis can be superficial and deep. The latter is divided into several forms, the most dangerous is panmastitis, in which the entire area of the gland is inflamed. When making a diagnosis, the classification of pathology is written in detail.

Diagnostics

Diagnostics plays an important role, since timely identification of the problem will allow for effective therapy and quickly eliminate the inflammatory process. The patient must carry out the initial diagnosis independently. This will allow you to identify the first symptoms of mastitis, suspect the presence of the disease and seek help from specialists.

When visiting a doctor, an examination is carried out and complaints are identified. The specialist palpates the breast, which allows you to make a diagnosis and determine a list of further examinations to determine effective treatment tactics.

Depending on the situation, the patient may be prescribed the following tests:

general blood analysis;
discharge from the nipples, to identify the causative agent of infection and sensitivity to antibiotics;
examination of milk for the presence of bacteria and leukocyte levels.

To accurately determine the location of inflammation, as well as its extent, an ultrasound examination is performed. If the clinical picture is questionable, a biopsy is prescribed to rule out the possibility of cancer. The list of studies may vary and depend on factors such as the presence of concomitant diseases, the stage of mastitis, and so on.

Prevention

It is almost impossible to completely exclude the possibility of the disease. However, you can reduce it to a minimum. To do this, it is enough to carry out a number of preventive measures:

It is necessary to breastfeed regularly, as well as express the remaining milk after each procedure.
When feeding, you need to properly attach the baby to the breast. The baby should be able to grasp the entire areola. This prevents damage to the delicate skin of the nipples.
Timely treatment of inflammatory processes occurring in the body also reduces the chances of mastitis.
Before and after each feeding, you need to prepare your breasts. The nipples are washed with warm water and then gently wiped with a clean towel.

Preventive measures also include self-examination of the mammary glands and regular visits to a specialist.

Stages

Mastitis is divided into several stages, which are characterized by certain symptoms and signs. The main classification of mastitis is as follows:

Serous is the initial stage of the disease, which responds well to treatment. At this stage, it is important to recognize the first symptoms: a slight inflammation forms, without visible changes on the skin. In this case, there is an enlargement of the mammary gland, pain and an increase in temperature.
Infiltrative - occurs two days after the lack of proper treatment for serous mastitis. The area of inflammation increases, and upon palpation you can feel a pronounced compaction (infiltrate).
Purulent - at this stage, purulent formations appear, causing a significant increase in temperature to 40 degrees and a sharp deterioration in well-being. The breasts become swollen, and the skin in the area of the mammary gland changes color.
Chronic – occurs due to improper treatment or lack thereof. In most cases, this is untreated mastitis of the mammary gland, which subsequently responds poorly to therapy.

In addition to those described, there are also several other classifications of mastitis:

Abscess – characterized by the presence of a purulent formation that is localized in a certain area and does not extend beyond its limits.
Phlegmonous is one of the advanced forms of purulent mastitis, when inflammation spreads throughout the mammary gland.
Gangrenous – a severe stage at which tissue necrosis occurs. The woman feels a sharp deterioration in her health, and her body temperature can rise above forty degrees. These symptoms require immediate hospitalization.

It is worth noting that mastitis in a nursing mother develops very intensively. In just a few hours, the disease can progress to the next stage. Therefore, when the first symptoms appear, you need to contact a clinic where professional help will be provided.

Is it possible to continue breastfeeding with mastitis?

With mastitis, the infection does not get into the milk, and it cannot harm the baby. And although breastfeeding with mastitis can be painful for mom, try not to stop breastfeeding. The more often the baby suckles at the breast where congestion has occurred, the faster it will be eliminated. You also need to continue feeding to strengthen the baby’s immunity, since breast milk has antibacterial properties.

Rarely, but sometimes breastfeeding with lactation mastitis can be too painful. Then try placing your baby on the healthy breast, and place a cloth or small towel under the breast with mastitis to absorb the dripping milk. Perhaps, after the sore breast is partially emptied, the pressure will decrease and feeding from it will not be so painful. You can also try expressing milk and feeding your baby or saving it for the future.

The discomfort of mastitis can be frustrating and discourage breastfeeding. But with timely treatment, the symptoms of mastitis quickly disappear, and mother and baby can again enjoy the benefits and process of breastfeeding.

How to prevent it?

The main task of prevention is to ensure the natural drainage function of the mammary gland - this will prevent stagnation of milk and create a favorable emotional background. We list the basic rules that must be followed to prevent the development of mastitis:

Immediately after birth you need to breastfeed - it is advisable to do this in the first 30 minutes. In the future, feeding should be continued, strictly observing the daily routine.
Always express the remaining milk - place your fingers around the periphery of the areola, do not pull on the breast or pinch the skin. Alternate these movements with a light massage.
Wear only a loose bra made from natural fabrics - the seams should not dig into the skin. If there is discharge from their nipple, use special wipes.
Do a light breast massage every day - gently, in a circular motion. The procedure should last 5-10 minutes.
If sores appear on the nipple, you should immediately consult a doctor. The doctor will prescribe medications for healing and special creams.

The best prevention is timely attendance at antenatal clinics and breast care. If you adhere to all of the above rules, the likelihood of developing pathology is very low. When symptoms of mastitis appear, urgent conservative therapy is required.

How does the disease begin?

Mastitis develops after infection enters through the nipple opening. As a result of infection, pathogenic microorganisms settle on the wall of the duct. When milk stagnates, favorable conditions are created for the reproduction and growth of colonies, which gradually causes the death of gland cells.

The disease goes through three stages:

Serous-infiltrative – acute mastitis begins with it. The affected tissues swell, and there is an accumulation of leukocytes - protective cells for destroying microbes. All pathological processes at this stage are still reversible.
Stage of phlegmon - if the pathogen is not destroyed, the colonies infect new tissues, causing the death of entire areas. There is limited accumulation of pus.
Gangrene develops if left untreated. It is characterized by blockage of large vessels with blood clots or their compression by growing purulent foci. Due to poor circulation, most of the gland dies.

How to treat?

Treatment for mastitis requires mandatory cessation of breastfeeding, since Staphylococcus aureus can cause dangerous diseases in the child. You also need to remember that any medicine penetrates the glandular tissue, and then into the milk.

At the initial stages, conservative therapy is prescribed. It includes:

Drugs to reduce lactation (Dostinex, Bromocriptine) are prescribed by a doctor to relieve the strain on the mammary gland. When taking them, breastfeeding is strictly prohibited.
Expressing breast milk - done 4-5 times a day, the procedure begins with the sore breast. For severe pain, a novocaine blockade is first done.
Analgesics (Nise, Ibuprofen) or antispasmodics (Papaverine, No-Shpa) are prescribed for severe local symptoms. Medicines help cope with the manifestations of pathology.
Antibiotics for mastitis (Clarithromycin, Erythromycin) are prescribed by a doctor when Staphylococcus aureus is detected. Taken in courses along with painkillers.

In case of phlegmonous form or in the presence of an abscess, surgery is prescribed. During surgery, purulent foci are opened, drainage of the contents is performed, followed by disinfection. In case of gangrene, the entire gland must be removed. After the intervention, a course of antibiotics is indicated.