Mastitis or Breast Infection Care

Mastitis is usually during lactation

Post-partum period is a period between the delivery until the reproduction system back to normal condition. We need to underline that this period is in non-pregnant condition, but in pregnancy. This period is also called puerperal period. The recovery period will back in 6 weeks postpartum.

Pregnancy, childbirth and breastfeeding is a physiological process that needs to be prepared by the women or couples so that this period will be safe. During pregnancy, the mother and the fetus is an integral function units that can not separate between them.

Breast Anatomy

The breast anatomy consist of alveoli, lactiferous duct, lactiferous sinus, ampulla, pore papilla and alveolar edge. Lymphatic drainage of the breast approximately 75% to the axilla or armpit area. Another lymphatic drainage is to parasternal nodes, in detail to central and medial area and some interpectoral gland.

Breast Function

Breast has three changes that affected the hormone. The first change starts from child to puberty, fertility period, climacteric, and menopause. Since puberty period, the influence  of estrogen and progesterone produced by the ovaries and pituitary hormones, it will cause growing and development of ductal acini.

The second change is the changes in the menstrual cycle. After the eighth day of menstruation, breasts become larger and in a few days before the next menstruation the breast will be maximum size. Sometimes the breast is felt painful and swollen. For several days before menstruation breast becomes tense and painful toward physical examination, especially palpation assessment. In the mammogram assessment is not assessable because the contrast of the breast is too large. When enter the menstruation time, the pain and swelling is reduced.

The third change occurs during pregnancy and lactation. In pregnancy, the breasts become larger because lobule ductal epithelium and alveolar ducts proliferate, develop and grow new duct.

The secretion of the hormone prolactin from the anterior pituitary gland inside the brain will trigger lactation. The milk produced by the cells of the alveoli, acini fill, then it will excrete through the ducts to the nipple.

Definition Mastitis

Mastitis is an inflammation in the breast because of infection or non-infection. The infection usually caused by staphylococcus aureus through the wound in nipple or blood flow. This disease usually occurs in lactation period , so it is usually called lactation mastitis or mastitis puerperal. This disease can be fatal if there is no adequate treatment.

Breast abscess or local pus is a severe complication in mastitis. Mastitis can be divided in many type based on its causes and condition.

1. Mastitis based on its location:
2. Mastitis that cause abscess under areola
3. Mastitis in the middle of breast
4. Mastitis under dorsal glands and its abscess in the muscle.

Mastitis based on its causes:

Periductal Mastitis

Periductal mastitis occurs in woman before menopause, the cause of this mastitis is unknown. This condition usually called ectasia duct, it means blockage in breast duct.

Lactational or Puerperal Mastitis

This mastitis usually occurs in pregnancy and lactation. The main cause of this mastitis are germs in mother breast that transmitted to nipple by direct contact.

Mastitis Supurative

Mastitis supurative is common mastitis, this cause of mastitis is staphylococcus, fungi, TBC, and syphilis. TBC infection needs extra intensive treatment. If the treatment is not complete, the breast removal can be done for it.

Etiology

The main cause of mastitis is breast milk stasis and infection. Breast milk stasis is usually the primary cause which may be make infection in it.

Breast Milk Statis

Breast Milk statis will occur if breast milk is not flow efficiently. This condition occurs when breast produce immediately after birth and the baby does not suck milk, baby's power is bad in sucking breast milk, ineffective in sucking, restrictions on the frequency / duration in breastfeeding, blockage of the ducts, high milk supply and breastfeeding for twin.

Infection

The most common organisms found in mastitis and breast abscess are Staphylococcus aureus and Staphylococcus albas. Escherichia coli and Streptococcus sometimes can be found. Mastitis may be found as a complication of typhoid fever.

Staphylococcus Aureus

Predisposition factors

Some factors that may increase the risk of mastitis:

Age

21-35 years old women are more often suffer from mastitis than women under 21 years old or above 35 years old.

Parity

Mastitis is usually in first pregnancy.

Mastitis History

The first mastitis attacks tend to be recurrent, this is because of poor breastfeeding techniques.

Childbirth

Complications of delivery may increase the risk of mastitis disease, but the use of oxytocin hormone does not increase the risk of mastitis disease.

Nutrition

Salt and high fat intake and anemia lead to mastitis. Antioxidants such as like vitamin E, vitamin A and selenium may reduce the risk of mastitis.

Immune Factors

Immune system play role in protecting the infection. Immune factors in breast milk may provide a defense mechanism in the breast.

Stress and Fatigue

Women who is sick and fever often feel tired and want to rest, but it is unclear whether fatigue can cause this condition or not.

Work

This mastitis can be caused by breast milk static, it is because of the long interval between breastfeeding and lack of time in spending adequate breast milk.

Trauma

Trauma in breast can damage breast gland tissue and ducts and this can cause mastitis.

Mastitis Sign and Symptoms

1. Breast pain, tension, or swelling
2. Redness with clear boundaries
3. Usually only affect one breast
4. Occurred between 3-4 weeks postpartum

Prevention

Breast care during lactation is an important effort to prevent mastitis. The breast care consists of cleaning the breast with soap before and after feeding to remove scale and dried milk. Besides that breast care also can prevent the baby from infection. If there is an injury to the nipples, the baby should not breastfeed in mother's milk until the wound healed. Breast milk can be excreted by a massage.

Breastfeeding Position

The position of the baby during breastfeeding is very important in effectiveness breastfeeding and prevent breast milk stasis, then make sure the mother hug her baby properly. The young mother will need help in breastfeeding.

Correct breastfeeding position:

1. Mother's arm sustains his baby's head, neck, and the baby's body (baby's head and body are in a straight line) baby's face is facing the mother's breast. Put the baby's nose in front of mother's breast, the baby's position should be in front of the mother's stomach.
2. Mothers makes the baby close to the body and the mothers must observe the baby during breastfeeding.
3. Mother put the nipple to baby's mouth, wait until the baby's mouth is wide open and then put the baby's mouth to the mother's nipple so that the baby's lips can catch the nipple.

Correct breast feeding position

Good breastfeeding in baby must:

1. Chin touches the breast.
2. Mouth wide open.
3. The baby's nose touching the breast.
4. The baby's mouth covers the areola.
5. The infant's tongue sustain the nipple and lower areola.
6. Babies suck deep, strong, and slowly.

Treatment

Soon after mastitis was diagnosed, breast that has mastitis is stopped and antibiotics is prescription. By this treatment, the abscess is often preventable because it is usually caused by Stapilococus aureus infection. Penicillin in high enough doses can be prescribed too. Before penicillin prescription, it can test the infection in breast milk, so that the cause of mastitis is completely known and the best antibiotic can be prescribed. If there is an abscess and pus removed, next is installed pipes to the middle of the abscess so that the pus can come out constantly.

In summary, mastitis is an infection that occurs in 1-2% of women who are in lactation period. Mastitis is common disease in 1-5 weeks after childbirth, especially in first pregnancy. Infection occurs through wounds on the nipple, but possibly also through blood circulation. Mastitis is characterized by pain in the breast, redness, swollen breast area, fever, and the patient feels weak and no appetite. Mastitis occurred a few weeks after childbirth. The common causes are Stapilococus aureus infection.

Mastitis is treated with antibiotics prescription. Breast infection or mastitis should be concerned by mothers who had just had childbirth. These infections usually occur approximately two weeks after childbirth, mastitis is caused by bacteria that live on the surface of the breast. Fatigue, stress, and tight clothing can cause blockage of the breast ducts, if it is not treated properly it leads to abscess and worse is breast removal.