Can you protect yourself from mastitis while breastfeeding? Is it possible to do without antibiotics when treating mastitis? Can I continue breastfeeding if I have mastitis? Is surgery necessary if mastitis is diagnosed?
The diagnosis of mastitis is surrounded by so many myths and fears that many nursing mothers begin to fear it in advance. In this article we will try to figure out what is the best prevention of mastitis, when antibacterial therapy (antibiotic treatment) is adequate, in which cases - surgical intervention, and in which cases the mother can cope on her own by making the necessary adjustments to the organization of breastfeeding.
Mastitis is an inflammation of the mammary gland that goes through a number of stages. As the inflammatory process develops, an infection may join. Therefore, the determining factor when choosing a treatment strategy is the presence or absence of a bacterial infection in the mother’s body.
Prevention of mastitis:
If milk is removed from the breast ineffectively (infrequent feedings, improper latching of the breast, feeding through), then there is a high probability of mastitis.
Please note that pumping"remains" of milk after feeding does not prevent mastitis. Moreover, when feeding on demand, pumping leads to excessive milk production, which, in turn, is more likely to lead to the problem of stagnation, mastitis.
And only in cases where the mother is separated from the baby, or the baby cannot eat often due to weakness (for example, due to prematurity), it helps to empty the breast in a timely manner and maintain lactation until the baby is able to independently suckle the breast in the required volume.
Non-infectious mastitis
Non-infectious mastitis - stagnation of milk in the breast, milk stasis,.
Lasts from one to three to four days, accompanied by chest pain, redness of part of the breast, a rise in temperature (sometimes from the very first day of stagnation), you can often feel a lump inside the mammary gland. Pain may also appear or intensify when applied or sucked.
In most cases, at this stage the problem can be dealt with without resorting to antibiotic treatment, because An infection in the chest most often does not have time to develop in such a short period.
In the case when there are already cracks on the breast, or stagnation of milk occurs against the background infectious disease, i.e. There is already an infection in the mother’s body or an open “gate of entry” for it, this can accelerate the development of infectious mastitis (the stage following non-infectious mastitis), so you should consult a doctor immediately.
What a mother should do if non-infectious mastitis occurs:
- frequent feeding from a sore breast;
- control of the baby’s correct latching on the breast;
- selection suitable posture(convenient and comfortable for the mother, without pressure on the place of congestion, the newborn baby can be positioned with the chin to the place of compaction);
- apply cold to the area of swelling and redness for 7-10 minutes;
- antipyretics, compatible with breastfeeding (if necessary).
mother in mandatory continues to breastfeed the baby, following the above principles of working with mastitis and medical recommendations.
Infectious mastitis does not require cessation of breastfeeding, because First of all, it is desirable to ensure the most efficient milk flow. The baby's sucking is optimal for solving this problem as well. Many health care workers are concerned about possible risk infection of the baby, especially if pus is visible in the milk.
They recommend hand expressing and discarding such breast milk. However, a large number of studies have shown that continued breastfeeding is usually safe for the baby's health, even in the presence of Staph. Aureus (staphylococcus).
Purulent mastitis
In the absence of timely action and adequate treatment, infectious mastitis progresses to the next stage, purulent mastitis(abscessing or phlegmonous).
An abscess is a severely painful, inflamed lump or red lump that is hot to the touch with swelling of the surrounding skin. A less favorable course of the disease is characterized by the spread purulent inflammation by gland tissue, phlegmonous mastitis. In case of purulent mastitis surgery required, removal of pus from breast tissue. After surgery and short recovery period we can continue breast-feeding even against the backdrop of supportive antibacterial therapy(). If during the period of surgery and recovery the mother is separated from the baby, it is necessary to organize regular breastfeeding to ensure timely emptying of the breast and maintain lactation.
Recurrent mastitis may be caused by late or inadequate treatment of the initial problem or improper breastfeeding technique. In some cases, repeated episodes of mastitis are caused by. In rare cases, there is a problem with the breasts that causes persistently poor drainage in part of the breast, such as a milk duct abnormality, cyst, or growth in the breast tissue.
Thus, not every mastitis is a “sentence” to compulsory treatment antibiotics, surgery and stopping breastfeeding. A the best prevention inflammation of the mammary gland is breastfeeding, organized in a natural way - at the request of the baby in the first place, and at the request of the mother, if necessary, if she feels that the breast is very full and requires emptying. Also decisive factor prevention is the quality of breastfeeding, when the baby grasps the breast deeply (about 4.5 - 5 cm in diameter), does not “click” when sucking, turns his lips out correctly, and the mother does not experience any painful or uncomfortable sensations during feeding.
If you have any doubts about the quality of the application, it is better to consult with. The specialist will tell you how to properly and deeply insert the breast into your baby’s mouth, and will also help you choose comfortable positions for feeding.
Have fun breastfeeding and be healthy!
Ekaterina Skorokhodova (Aganesova), lactation consultant.
Ruslan Lukyanchuk, surgeon.
"Mastitis. Causes and management” Department of Child and Adolescent Health and Development, World Health Organization, Geneva 2000. Page 16
"Recurring mastitis - what can I do?" based on materials International organization La Leche League/Lalecheleague http://www.llli.org/russian/faq/repeated_mastitis.html
"Mastitis. Causes and management” Department of Child and Adolescent Health and Development, World Health Organization, Geneva 2000. Page 25
"Mastitis. Causes and management” Department of Child and Adolescent Health and Development, World Health Organization, Geneva 2000. Page 17
Many mothers are interested in whether it is possible to breastfeed with mastitis. Doctors repeat loudly that it is possible and even necessary in order to get rid of the disease as quickly as possible. Let's tell you in more detail.
Mastitis is a disease that usually occurs during breastfeeding or when a baby is weaned. Women have to deal with this disease after three months from the birth of their baby. This is a disease of the mammary glands, accompanied by an inflammatory process. Statistics show that mastitis develops in approximately 5–6% of women who breastfeed.
After giving birth, every woman has to face new difficulties and learn something new every day. In the first days after birth, the main task of a new mother is to establish breastfeeding in order to avoid problems with the mammary glands and not leave her child hungry. At first glance, this task may seem simple, but in fact it requires a lot of effort, time and certain skills.
Causes of mastitis
In order to understand whether it is possible to feed a child with mastitis, it is necessary to identify the causes of this disease. And in order not to face the disease face to face, you need to pay attention to these reasons. So, the factors contributing to stagnation of milk in the breast can be called:
In order not to encounter mastitis, you need to avoid the factors described above and take care of yourself. If there is a lot of milk and the baby cannot eat it, it is recommended to express regularly. This measure is also necessary during the development of the disease itself.
To prevent mastitis, you need to properly attach the baby to the breast so that he eats as much milk as possible, this is the only way to prevent stagnation from forming, leading to the development of mammary gland disease. 
Is it possible to breastfeed a baby with inflammation of the mammary glands?
Many mothers who are faced with a disease such as mastitis are concerned about whether they can continue breastfeeding, because they don’t want to switch the baby to formula feeding. The answer is yes. It is necessary and even necessary to continue feeding in order to prevent complications.
Doctors have conducted a lot of research to determine whether it is safe to feed children with mastitis. It was possible to prove that this disease does not harm the baby in any way (does not affect the gastrointestinal tract). 
If a mother thinks that during mastitis she will only harm her child, then she is deeply mistaken. Doctors say that with this disease it is necessary to continue feeding to maintain lactation. Breast milk produces antibodies that can protect the baby from infections entering the body.
But, despite the fact that you can still breastfeed your baby, this may cause side effects. This is, first of all, warming up the baby, that is, a slight increase in body temperature. Indeed, in the body of a mother suffering from mastitis, there is inflammatory process, the symptom of which is an increase in body temperature. Accordingly, the milk reaches the baby warm and warms him up. But some time after feeding, his body temperature returns to normal. 
Important! During feeding, the mother not only improves the process of breastfeeding, she also alleviates her condition.
If you stop breastfeeding, there is a high chance of cessation of lactation, since during pumping the baby will wean off breast milk. He will understand that it is much easier to get food from a bottle, and therefore, after the mother’s treatment, he will refuse the breast.
When to stop breastfeeding
It is worth noting that not in all cases it is allowed to breastfeed a baby with mastitis. For example, if pus appears from the breast, you cannot continue feeding, as an infection may develop in the child’s body, especially when it comes to a newborn. 
Typically, mastitis develops in one of the breasts. In order not to completely wean your baby off breastfeeding, you can give him milk only from a healthy gland. To prevent the child from becoming unaccustomed to the other breast, it is necessary to express the pus from it until only milk remains, and feed the child with it.
The doctor may also suggest that a woman temporarily stop lactation in the following cases:
Treatment of mastitis
Sometimes women confuse the development of mastitis with stagnation of milk, which can be eliminated. First of all, you need to make sure that the mother is putting the baby to the breast correctly. If not, then it’s worth mastering the technique of proper application.
In order to be completely cured, you need to completely empty the breast: express part of it, and the baby must suck the rest. It is worth noting that no breast pump will cope with the task of emptying the breast better than a baby. But even after emptying, the breasts need to continue to be massaged, “breaking up” the lumps that have formed in the mammary glands. Stagnant milk should be driven closer to the nipple and expressed so that new stagnation does not form. 
In order to get rid of milk stagnation, the doctor may prescribe medications. But you cannot self-medicate, as this can harm the child. After all, there is no need to stop breastfeeding; you just need to select medications that are allowed to be combined with breastfeeding.
In order to get rid of mastitis as soon as possible and restore lactation, you need to start treating mastitis immediately after the first symptoms appear. In addition, to achieve an effective result, treatment must be completed, even if the disease has receded and no longer bothers you.
Treatment of mastitis - video
Mastitis in the old days they called it a baby. This pathology is an infectious-inflammatory process in tissues mammary gland, as a rule, having a tendency to spread, which can lead to purulent destruction of the gland body and surrounding tissues, as well as generalization of the infection with the development of sepsis (blood poisoning).
There are lactation (that is, associated with the production of milk by the gland) and non-lactation mastitis.
According to statistics, 90-95% of mastitis cases occur in postpartum period. Moreover, 80-85% develops in the first month after birth.
Mastitis is the most common purulent-inflammatory complication of the postpartum period. The incidence of lactation mastitis is about 3 to 7% (according to some data up to 20%) of all births and has not had a tendency to decrease over the past few decades.
Mastitis most often develops in nursing women after the birth of their first child. Usually the infectious-inflammatory process affects one gland, usually the right one. The predominance of damage to the right breast is due to the fact that for right-handed people it is more convenient to express the left breast, so stagnation of milk often develops in the right.
IN Lately There has been a trend toward an increase in the number of cases of bilateral mastitis. Today, a bilateral process develops in 10% of mastitis cases.
About 7-9% of lactation mastitis are cases of inflammation of the mammary gland in women who refuse to breastfeed; this disease is relatively rare in pregnant women (up to 1%).
Cases of the development of lactation mastitis in newborn girls are described, during the period when increased level hormones received from the mother’s blood cause physiological swelling of the mammary glands.
About 5% of mastitis in women is not associated with pregnancy and childbirth. As a rule, non-lactational mastitis develops in women aged 15 to 60 years. In such cases, the disease proceeds less violently, complications in the form of generalization of the process are extremely rare, but there is a tendency to transition to a chronically relapsing form.
Causes of mastitis
Inflammation with mastitis is caused by a purulent infection, predominantly Staphylococcus aureus. This microorganism causes various suppurative processes in humans, from local skin lesions (acne, boils, carbuncle, etc.) to fatal damage to internal organs (osteomyelitis, pneumonia, meningitis, etc.).Any suppurative process caused by Staphylococcus aureus can be complicated by generalization with the development of septic endocarditis, sepsis or infectious-toxic shock.
Recently, cases of mastitis caused by association of microorganisms have become more frequent. The most common combination of Staphylococcus aureus with gram-negative Escherichia coli (common in environment microorganism that normally inhabits the human intestine).
Lactation mastitis
In cases where we are talking about classic postpartum lactation mastitis, the source of infection most often becomes hidden bacteria carriers from medical personnel, relatives or roommates (according to some data, about 20-40% of people are carriers of Staphylococcus aureus). Infection occurs through contaminated care items, linen, etc.
In addition, a newborn infected with staphylococcus can become a source of infection for mastitis, for example, with pyoderma (pustular skin lesions) or in the case of umbilical sepsis.
However, it should be noted that contact with Staphylococcus aureus on the skin of the mammary gland does not always lead to the development of mastitis. For the occurrence of an infectious-inflammatory process, it is necessary to have favorable conditions - local anatomical and systemic functional ones.
Thus, local anatomical predisposing factors include:
- gross scar changes in the gland, remaining after severe forms of mastitis, operations for benign neoplasms and so on.;
- congenital anatomical defects (retracted flat or lobulated nipple, etc.).
- pregnancy pathology (late pregnancy, premature birth, threatened miscarriage, severe late toxicosis);
- birth pathology (trauma birth canal, first birth with a large fetus, manual separation of the placenta, severe blood loss during childbirth);
- puerperal fever;
- exacerbation of concomitant diseases;
- insomnia and others psychological disorders after childbirth.
Non-lactation mastitis
Develops, as a rule, against the background of a decrease in general immunity (transferred viral infections, heavy accompanying illnesses, sudden hypothermia, physical and mental stress, etc.), often after microtrauma of the mammary gland.
The causative agent of non-lactation mastitis, as well as mastitis associated with pregnancy and lactation, in most cases becomes Staphylococcus aureus.
To understand the features of the mechanism of development of lactational and non-lactational mastitis, it is necessary to have a general understanding of the anatomy and physiology of the mammary glands.
Anatomy and physiology of the mammary glands
The mammary gland is an organ reproductive system, intended for the production of human milk during the postpartum period. This secretory organ is located inside a formation called the breast.The mammary gland contains a glandular body surrounded by well-developed subcutaneous fatty tissue. It is the development of the fat capsule that determines the shape and size of the breast.
On the most protruding part of the chest fat layer absent - here is the nipple, which, as a rule, has a cone-shaped, less often cylindrical or pear-shaped.
The pigmented areola makes up the base of the nipple. In medicine, it is customary to divide the mammary gland into four areas - quadrants, bounded by conditional mutually perpendicular lines.
This division is widely used in surgery to indicate the localization of the pathological process in the mammary gland.
The glandular body consists of 15-20 radially located lobes, separated from each other by fibrous connective tissue and loose fatty tissue. The bulk of the glandular tissue itself, which produces milk, is located in the posterior parts of the gland, while ducts predominate in the central regions.
From the anterior surface of the gland body, through the superficial fascia that limits the fatty capsule of the gland, dense connective tissue strands are directed to the deep layers of the skin and to the collarbone, representing a continuation of the interlobar connective tissue stroma - the so-called Cooper ligaments.
Basic structural unit The mammary gland is an acinus, consisting of the smallest formations of vesicles - alveoli, which open into the alveolar ducts. The inner epithelial lining of the acinus produces milk during lactation.
The acini are united into lobules, from which the milk ducts depart, merging radially towards the nipple, so that the individual lobules unite into one lobe with a common collecting duct. The collecting ducts open at the top of the nipple, forming an expansion - the milk sinus.
Lactation mastitis proceeds less favorably than any other purulent surgical infection, this is due to the following features of the anatomical and functional structure of the gland during lactation:
- lobular structure;
- a large number of natural cavities (alveoli and sinuses);
- developed network of milk and lymphatic ducts;
- abundance of loose fatty tissue.
So, without adequate treatment, the purulent process quickly engulfs the entire gland and often takes a protracted, chronically relapsing course. In severe cases, purulent melting of large areas of the gland and the development of septic complications (infectious-toxic shock, blood poisoning, septic endocarditis, etc.) are possible.
Mechanism of development of the infectious-inflammatory process
The mechanism of development of lactational and non-lactational mastitis has some differences. In 85% of cases lactation mastitis the disease develops against the background of milk stagnation. In this case, lactostasis, as a rule, does not exceed 3-4 days.Acute lactation mastitis
With regular and complete expression of milk, bacteria that inevitably fall on the surface of the mammary gland are washed away and are not capable of causing inflammation.
In cases where adequate pumping does not occur, a large number of microorganisms accumulate in the ducts, which cause lactic fermentation and milk coagulation, as well as damage to the epithelium of the excretory ducts.
Curdled milk together with particles of desquamated epithelium clog the milk ducts, resulting in the development of lactostasis. Quite quickly, the amount of microflora that multiplies intensively in a confined space reaches critical level, and infectious inflammation develops. At this stage, secondary stagnation of lymph and venous blood occurs, which further aggravates the condition.
The inflammatory process is accompanied by severe pain, which in turn makes it difficult to express milk and aggravates the state of lactostasis, so that a vicious circle is formed: lactostasis increases inflammation, inflammation increases lactostasis.
In 15% of women, purulent mastitis develops against the background of cracked nipples. Such damage occurs due to the discrepancy between the sufficiently strong negative pressure in the child’s oral cavity and the weak elasticity of the nipple tissue. Purely hygienic factors can play a significant role in the formation of cracks, such as, for example, prolonged contact of the nipple with the damp fabric of the bra. In such cases, irritation and weeping of the skin often develops.
The occurrence of cracks often forces a woman to give up breastfeeding and careful pumping, which causes lactostasis and the development of purulent mastitis.
To avoid nipple damage when breastfeeding, it is very important to latch your baby to the breast at the same time every day. In such cases, the correct biorhythm of milk production is established, so that the mammary glands are, as it were, prepared for feeding in advance: milk production increases, the milk ducts expand, the lobules of the gland contract - all this contributes to the easy release of milk during feeding.
With irregular feeding, the functional activity of the glands increases already during feeding; as a result, individual lobules of the gland will not be completely emptied and lactostasis will occur in certain areas. In addition, with an “unready” breast, the baby has to expend more effort while sucking, which contributes to the formation of nipple cracks.
Non-lactation mastitis
At non-lactation mastitis the infection, as a rule, penetrates the gland through damaged skin due to an accidental injury, thermal injury (a heating pad, tissue burn in an accident), or mastitis develops as a complication of local pustular skin lesions. In such cases, the infection spreads through the subcutaneous fatty tissue and fatty capsule of the gland, and the glandular tissue itself is damaged again.
(Non-lactation mastitis, which arose as a complication of a breast boil).
Symptoms and signs of mastitis
Serous stage (form) of mastitis
The initial or serous stage of mastitis is often difficult to distinguish from banal lactostasis. When milk stagnation occurs, women complain of heaviness and tension in the affected breast; a mobile, moderately painful lump with clear segmental boundaries is palpated in one or more lobes.Expressing with lactostasis is painful, but the milk comes out freely. The woman's general condition is not affected and her body temperature remains within normal limits.
As a rule, lactostasis is a temporary phenomenon, so if within 1-2 days the compaction does not decrease in volume and persistent low-grade fever appears (increase in body temperature to 37-38 degrees Celsius), then serous mastitis should be suspected.
In some cases, serous mastitis develops rapidly: the temperature suddenly rises to 38-39 degrees Celsius, and complaints of general weakness and pain in the affected part of the gland appear. Expressing milk is extremely painful and does not bring relief.
At this stage, the tissue of the affected part of the gland is saturated with serous fluid (hence the name of the form of inflammation), into which, a little later, leukocytes (cells that fight foreign agents) enter from the bloodstream.
At the stage of serous inflammation, spontaneous recovery is still possible, when pain in the gland gradually subsides and the lump completely resolves. However, much more often the process moves into the next - infiltrative phase.
Considering the seriousness of the disease, doctors advise that any significant engorgement of the mammary glands, accompanied by an increase in body temperature, should be considered the initial stage of mastitis.
Infiltrative stage (form) of mastitis
The infiltrative stage of mastitis is characterized by the formation of a painful compaction in the affected gland - an infiltrate that has no clear boundaries. The affected mammary gland is enlarged, but the skin above the infiltrate at this stage remains unchanged (redness, local increase in temperature and swelling are absent).Elevated temperature during the serous and infiltrative stages of mastitis is associated with the entry of human milk from foci of lactostasis into the blood through damaged milk ducts. Therefore, when effective treatment lactostasis and desensitizing therapy, the temperature can be reduced to 37-37.5 degrees Celsius.
In the absence of adequate treatment, the infiltrative stage of mastitis passes into the destructive phase after 4-5 days. In this case, serous inflammation is replaced by purulent inflammation, so that the gland tissue resembles a sponge soaked in pus or a honeycomb.
Destructive forms of mastitis or purulent mastitis
Clinically, the onset of the destructive stage of mastitis is manifested by a sharp deterioration general condition patient, which is associated with the entry of toxins from the focus of purulent inflammation into the blood. Body temperature rises significantly (38-40 degrees Celsius and above), weakness appears, headache, sleep worsens, appetite decreases.
The affected breast is enlarged and tense. In this case, the skin over the affected area turns red, the skin veins dilate, and the regional (axillary) lymph nodes often become enlarged and painful.
Abscess mastitis characterized by the formation of cavities filled with pus (abscesses) in the affected gland. In such cases, softening is felt in the area of infiltration; in 99% of patients, the symptom of fluctuation is positive (a feeling of iridescent liquid when palpating the affected area).
(Localization of ulcers in abscess mastitis:
1. - subalveolar (near the nipple);
2. - intramammary (inside the gland);
3. - subcutaneous;
4. - retromammary (behind the gland) 
Infiltrative abscess mastitis, as a rule, is more severe than an abscess. This form is characterized by the presence of a dense infiltrate consisting of many small abscesses various shapes and magnitude. Since the ulcers inside the infiltrate do not reach large sizes, the painful compaction in the affected gland may appear homogeneous (the symptom of fluctuation is positive in only 5% of patients).
In approximately half of the patients, the infiltrate occupies at least two quadrants of the gland and is located intramammary. 
Phlegmonous mastitis characterized by total enlargement and severe swelling of the mammary gland. In this case, the skin of the affected breast is tense, intensely red, in places with a cyanotic tint (bluish-red), the nipple is often retracted.
Palpation of the gland is sharply painful; most patients have a pronounced symptom of fluctuation. In 60% of cases, at least 3 quadrants of the gland are involved in the process.
As a rule, disturbances in laboratory blood parameters are more pronounced: in addition to an increase in the number of leukocytes, there is a significant decrease in hemoglobin levels. The indicators of the general urine analysis are significantly impaired. 
Gangrenous mastitis develops, as a rule, as a result of involvement in the process blood vessels and the formation of blood clots in them. In such cases, as a result of a gross disruption of the blood supply, necrosis of large areas of the mammary gland occurs.
Clinically, gangrenous mastitis is manifested by an enlargement of the gland and the appearance on its surface of areas of tissue necrosis and blisters filled with hemorrhagic fluid (ichor). All quadrants of the mammary gland are involved in the inflammatory process; the skin of the breast takes on a bluish-purple appearance.
The general condition of patients in such cases is severe; confusion is often observed, the pulse quickens, and blood pressure drops. Many laboratory parameters of blood and urine tests are disrupted.
Diagnosis of mastitis
If you suspect inflammation of the mammary gland, you should seek help from a surgeon. In relatively mild cases, nursing mothers can consult their attending physician at the antenatal clinic.As a rule, making a diagnosis of mastitis does not cause any particular difficulties. The diagnosis is determined based on the patient’s characteristic complaints and examination of the affected mammary gland.
As a rule, laboratory tests are carried out:
- bacteriological examination of milk from both glands (qualitative and quantitative determination of microbial bodies in 1 ml of milk);
- cytological examination milk (counting the number of red blood cells in milk as markers of the inflammatory process);
- determination of milk pH, reductase activity, etc.
In abscess and phlegmonous forms of mastitis, puncture of the infiltrate is performed with a wide-lumen needle, followed by bacteriological examination of the pus.
In controversial cases, which often arise in the case of chronic course process, appoint X-ray examination breast (mammography).
In addition, in case of chronic mastitis, it is imperative to carry out differential diagnosis with breast cancer, this requires a biopsy (sampling of suspicious material) and histological examination.
Treatment of mastitis
Indications for surgery are destructive forms of infectious and inflammatory process in the mammary gland (abscess, infiltrative-abscess, phlegmonous and gangrenous mastitis).The diagnosis of the destructive process can be unambiguously made in the presence of foci of softening in the mammary gland and/or positive symptom fluctuations. These signs are usually combined with a violation of the patient’s general condition.
However, erased forms of destructive processes in the mammary gland are often encountered, and, for example, with infiltrative abscess mastitis, it is difficult to detect the presence of foci of softening.
Diagnosis is complicated by the fact that banal lactostasis often occurs with a disturbance in the general condition of the patient and severe pain in the affected breast. Meanwhile, as practice shows, the issue of the need for surgical treatment should be resolved as soon as possible.
In controversial cases, to determine medical tactics, first of all, carefully express milk from the affected breast, and then after 3-4 hours, re-examine and palpate the infiltrate.
In cases where it was only a question of lactostasis, after expressing the pain subsides, the temperature drops and the general condition of the patient improves. Fine-grained, painless lobules begin to be palpated in the affected area.
If lactostasis was combined with mastitis, then even 4 hours after pumping, a dense painful infiltrate continues to be palpated, the body temperature remains high, and the condition does not improve.
Conservative treatment of mastitis is acceptable in cases where:
- the patient's general condition is relatively satisfactory;
- the duration of the disease does not exceed three days;
- body temperature below 37.5 degrees Celsius;
- none local symptoms purulent inflammation;
- pain in the area of infiltration is moderate, palpable infiltrate occupies no more than one quadrant of the gland;
- General blood test results are normal.
Surgery for mastitis
Surgeries for mastitis are performed exclusively in a hospital setting, under general anesthesia (usually intravenous). At the same time, there are basic principles for the treatment of purulent lactation mastitis, such as: - when choosing the surgical approach (incision site), the need to preserve the function and aesthetic appearance of the mammary gland is taken into account;
- radical surgical treatment (thorough cleansing of the opened abscess, excision and removal of non-viable tissue);
- postoperative drainage, including the use of a drainage-washing system (long-term drip irrigation of the wound in postoperative period).
Typically, incisions for purulent mastitis are made in a radial direction from the nipple through the area of fluctuation or greatest pain to the base of the gland.
In case of extensive destructive processes in the lower quadrants of the gland, as well as in case of retromammary abscess, the incision is made under the breast.
For subalveolar abscesses located under the nipple, the incision is made parallel to the edge of the nipple.
Radical surgical treatment includes not only removal of pus from the lesion cavity, but also excision of the formed abscess capsule and non-viable tissue. In the case of infiltrative-abscess mastitis, the entire inflammatory infiltrate within the boundaries of healthy tissue is removed.
Phlegmonous and gangrenous form mastitis requires the maximum volume of surgery, so that in the future, plastic surgery of the affected mammary gland may be necessary.
The installation of a drainage and lavage system in the postoperative period is carried out when more than one quadrant of the gland is affected and/or the patient’s general condition is severe.
As a rule, drip irrigation of the wound in the postoperative period is carried out for 5-12 days, until the patient’s general condition improves and components such as pus, fibrin, and necrotic particles disappear from the rinsing water.
In the postoperative period it is carried out drug therapy, aimed at removing toxins from the body and correcting general disorders in the body caused by the purulent process.
Antibiotics are mandatory (most often intravenously or intramuscularly). In this case, as a rule, drugs from the group of 1st generation cephalosporins (cefazolin, cephalexin) are used, when staphylococcus is combined with E. coli - 2nd generation (cefoxitin), and in the case of a secondary infection - 3rd-4th generation (ceftriaxone, cefpirome). In extremely severe cases, thienam is prescribed.
With destructive forms of mastitis, as a rule, doctors advise stopping lactation, since feeding a child from an operated breast is impossible, and pumping in the presence of a wound causes pain and is not always effective.
Lactation is stopped with medication, that is, drugs are prescribed that stop the secretion of milk - bromocriptine, etc. Routine methods of stopping lactation (breast bandaging, etc.) are contraindicated.
Treatment of mastitis without surgery
Most often, patients seek medical care with symptoms of lactostasis or initial stages mastitis (serous or infiltrative mastitis).In such cases, women are prescribed conservative therapy.
First of all, you should provide rest to the affected gland. To do this, patients are advised to limit motor activity and wear a bra or bandage that supports but does not compress the sore breast.
Since the trigger for the occurrence of mastitis and the most important link in the further development of the pathology is lactostasis, a number of measures are taken to effectively empty the mammary gland.
- A woman should express milk every 3 hours (8 times a day) - first from a healthy gland, then from a sick one.
- To improve milk flow, 20 minutes before expressing from the diseased gland, 2.0 ml of the antispasmodic drotaverine (No-shpa) is injected intramuscularly (3 times a day for 3 days at regular intervals), 5 minutes before expressing - 0.5 ml of oxytocin, which improves milk yield.
- Since expressing milk is difficult due to pain in the affected gland, retromammary examinations are performed daily. novocaine blockades, while the anesthetic novocaine is administered in combination with antibiotics wide range action at half the daily dose.
Since many unpleasant symptoms the initial stages of mastitis are associated with the penetration of milk into the blood, so-called desensitizing therapy with antihistamines is carried out. In this case, preference is given to drugs of a new generation (loratadine, cetirizine), since drugs of previous generations (suprastin, tavegil) can cause drowsiness in a child.
To increase the body's resistance, vitamin therapy (B vitamins and vitamin C) is prescribed.
If the dynamics are positive, ultrasound and UHF therapy are prescribed every other day, promoting rapid resorption of the inflammatory infiltrate and restoration of the functioning of the mammary gland.
Traditional methods of treating mastitis
It should immediately be noted that mastitis is surgical disease, therefore, at the first signs of an infectious-inflammatory process in the mammary gland, you should consult a doctor who will prescribe proper treatment. In cases where conservative therapy is indicated, in combination medical events means are often used traditional medicine.
So, for example, in the initial stages of mastitis, especially in combination with cracked nipples, you can include procedures for washing the affected breast with an infusion of a mixture of chamomile flowers and yarrow herb (in a ratio of 1:4).
To do this, pour 2 tablespoons of raw material into 0.5 liters of boiling water and leave for 20 minutes. This infusion has a disinfectant, anti-inflammatory and mild analgesic effect.
It should be remembered that in the initial stages of mastitis, under no circumstances should you use warm compresses, baths, etc. Warming up can provoke a suppurative process.
Prevention of mastitis
Prevention of mastitis consists, first of all, in the prevention of lactostasis, as the main mechanism for the occurrence and development of an infectious-inflammatory process in the mammary gland.
Such prevention includes the following measures:
- Early attachment of the baby to the breast (in the first half hour after birth).
- Developing a physiological rhythm (it is advisable to feed the baby at the same time).
- If there is a tendency to stagnation of milk, it may be advisable to perform a circular shower 20 minutes before feeding.
- Compliance with the technology of correct milk expression (the manual method is the most effective, and it is necessary Special attention be given to the outer quadrants of the gland, where stagnation of milk is most often observed).
In addition, wearing a cotton bra helps prevent cracked nipples. In this case, it is necessary that the fabric in contact with the nipples is dry and clean.
Predisposing factors for the occurrence of mastitis include nervous and physical stress, so a nursing woman should monitor her psychological health, get good sleep and eat well.
Prevention of mastitis not associated with breastfeeding consists of observing personal hygiene rules and timely adequate treatment skin lesions breasts
Is it possible to breastfeed with mastitis?
According to the latest WHO data, breastfeeding during mastitis is possible and recommended: " ...a large number of studies have shown that continued breastfeeding is usually safe for the baby's health, even in the presence of Staph. aureus. Only if the mother is HIV positive is there a need to stop feeding the infant from the affected breast until she recovers."There are the following indications for interrupting lactation:
- severe destructive forms of the disease (phlegmonous or gangrenous mastitis, the presence of septic complications);
- appointment antibacterial agents in the treatment of pathology (when taking which it is recommended to refrain from breastfeeding)
- the presence of any reasons why the woman will not be able to return to breastfeeding in the future;
- the patient's wish.
With serous and infiltrative forms of mastitis, doctors usually advise trying to maintain lactation. In such cases, a woman should express milk every three hours, first from the healthy breast and then from the diseased breast.
Milk expressed from a healthy breast is pasteurized and then fed to the baby from a bottle; such milk cannot be stored for a long time either before or after pasteurization. Milk from a sore breast, where there is a purulent-septic focus, is not recommended for the baby. The reason is that for this form of mastitis, antibiotics are prescribed, during which breastfeeding is prohibited or not recommended (the risks are assessed by the attending physician), and the infection contained in such mastitis can cause severe digestive disorders in the infant and the need for treatment for the child.
Natural feeding can be resumed after all symptoms of inflammation have completely disappeared. To ensure that it is safe for the child to resume natural feeding, a preliminary bacteriological analysis milk.
What antibiotics are most often used for mastitis?
Mastitis is a purulent infection, so bactericidal antibiotics are used to treat it. Unlike bacteriostatic antibiotics, such drugs act much faster because they not only stop the proliferation of bacteria, but kill microorganisms.Today it is customary to select antibiotics based on the microflora’s sensitivity to them. Material for analysis is obtained during puncture of the abscess or during surgery.
However, at the initial stages, taking material is difficult, and carrying out such an analysis takes time. Therefore, antibiotics are often prescribed before such testing is performed.
In this case, they are guided by the fact that mastitis in the vast majority of cases is caused by Staphylococcus aureus or the association of this microorganism with Escherichia coli.
These bacteria are sensitive to antibiotics from the penicillin and cephalosporin groups. Lactation mastitis is a typical hospital infections, therefore, is most often caused by strains of staphylococci resistant to many antibiotics that secrete penicillinase.
To achieve the effect of antibiotic therapy, penicillinase-resistant antibiotics such as oxacillin, dicloxacillin, etc. are prescribed for mastitis.
As for antibiotics from the cephalosporin group, for mastitis, preference is given to drugs of the first and second generations (cefazolin, cephalexin, cefoxitin), which are most effective against Staphylococcus aureus, including against penicillin-resistant strains.
Is it necessary to apply compresses for mastitis?
Compresses for mastitis are used only in the early stages of the disease in combination with other therapeutic measures. Official medicine advises using semi-alcohol dressings on the affected chest at night. Among the folk methods you can use cabbage leaves with honey, grated potatoes, baked onions, burdock leaves. Such compresses can be applied both at night and between feedings.
After removing the compress, you should rinse your breasts with warm water.
However, it should be noted that the opinions of doctors themselves regarding compresses for mastitis are divided. Many surgeons indicate that warm compresses should be avoided as they can aggravate the disease.
Therefore, when the first symptoms of mastitis appear, you should consult a doctor to clarify the stage of the process and decide on treatment tactics for the disease.
What ointments can be used for mastitis?
Today, in the early stages of mastitis, some doctors advise using Vishnevsky ointment, which helps relieve pain, improve milk flow and resolve the infiltrate. Compresses with Vishnevsky ointment are used in many maternity hospitals. At the same time, a significant part of surgeons consider the therapeutic effect of ointments for mastitis to be extremely low and indicate the possibility of an adverse effect of the procedure: a more rapid development of the process due to stimulation of bacterial growth by elevated temperature.
Mastitis serious disease, which can lead to severe consequences. It is untimely and inadequate treatment that leads to the fact that 6-23% of women with mastitis experience relapses of the disease, 5% of patients develop severe septic complications, and 1% of women die.
Inadequate therapy (insufficiently effective relief of lactostasis, irrational prescription of antibiotics, etc.) in the early stages of the disease often contributes to the transition of serous inflammation into a purulent form, when surgery and associated unpleasant moments (scars on the mammary gland, disruption of the lactation process) are already inevitable . Therefore, it is necessary to avoid self-medication and seek help from a specialist.
Which doctor treats mastitis?
If you suspect acute lactation mastitis, you should seek help from a mammologist, gynecologist or pediatrician. At severe forms In purulent forms of mastitis, you should consult a surgeon.Often women confuse the infectious-inflammatory process in the mammary gland with lactostasis, which can also be accompanied by severe pain and increased body temperature.
Lactostasis and initial forms mastitis is treated on an outpatient basis, while for purulent mastitis hospitalization and surgery are required.
For mastitis that is not associated with childbirth and breastfeeding (non-lactation mastitis), contact a surgeon.
Breast disease during breastfeeding, caused by bacterial infections such as Staphylococcus aureus or Streptococcus entering a woman's body, it is called lactation mastitis (or postpartum mastitis).
Another common cause of mastitis is lactostasis (milk stagnation). When the ducts in the mammary glands become compressed and swollen, infection can occur very quickly. But if a nursing woman notices the first signs of mastitis and immediately reacts, then the situation can be resolved quickly and with a positive effect.
About the features of mastitis
The disease is more typical for primiparous women; mastitis often occurs at the time of lactation (that is, in the first weeks, when young mothers do not yet know how to properly handle lactating breasts). There are also problems with the mammary glands, and they often arise when the baby is weaned. In both cases, the causes of the disease are hormonal and functional changes in the female body.
The immune system, is actively restructuring to work in a new way, simply does not have time to suppress pathogenic flora. And microbes that are normally harmless become the cause of mastitis. Pathogens penetrate the mammary gland through microcracks in the nipples. When starting breastfeeding, nipples often suffer from inept attachment, and when weaning, they become rubbed with linen, etc.
In general, microcracks in the nipples contribute to the rapid spread of all kinds of inflammatory processes, for example, ordinary breast thrush can easily provoke the spread of infection in the breast.
Varieties of mastitis forms
Breast mastitis has 2 forms: infected and uninfected.
· Uninfected mastitis is an inflammation of the mammary gland tissue, often developing against the background of lactostasis, i.e. when normal milk flow is not ensured.
· The cause of infected mastitis is microbes (streptococcus, staphylococcus and some others) that penetrate through cracks in the nipples and cause inflammation.
If measures are not taken in a timely manner, mastitis will progress to the purulent stage - a breast abscess (i.e., purulent contents will appear in the tissues of the cavity). If primary mastitis is not completely cured, the risk of recurrent disease is very high.
More about the causes of mastitis
The causes of mastitis can be divided into certain groups.
1. Lactostasis. Most often leads to mastitis. A few days after giving birth, a woman’s body is ready for another important process - breastfeeding. The mammary gland begins to secrete milk instead of colostrum. Often for a mother, the first arrival of milk is accompanied by some inconveniences: breast pain and/or swelling, diarrhea, spontaneous slight leakage of milk. This is how the hormone prolactin acts. Often, at first, the milk supply is much larger than the newborn needs, and he simply does not have time to eat as much, or the woman does not breastfeed at all - thus, stagnation of milk appears - lactostasis.
2. A sharp hormonal change in the female body - the beginning or end of breastfeeding is accompanied by a decrease in immune forces, which is why pathogens easily overcome the protective barrier.
3. Nipples are not ready, i.e. The skin on the nipples is thin and very delicate. Due to the unfamiliarity with constant friction and errors in latching the baby, the nipples are easily injured and take quite a long time to heal. As a result, the path is open for various microbes.
4. Violation of hygiene requirements - nipples and breasts in general must be clean. If milk leaks, leave it for a long time Absolutely not on the chest. Use special breast pads for nursing mothers, wash linens and clothes thoroughly, because... The dairy environment is the most “favorable” for rapidly multiplying bacteria and infections.
5. Excessive cooling of the mammary gland is a direct path to inflammation.
6. Tumors of different origins within the breast.
Symptoms of mastitis
1. Temperature up to 380C or more, chills, weakness, headache, increased leukocytes in the blood. With mastitis, the elevated temperature persists even after expressing milk.
2. Soreness throughout the chest when touched. It is also worth thinking about mastitis if only the breast areola and/or nipple become swollen and painful, if you can feel the compaction of any duct with your hands.
3. The skin in the area where there is a lump or lump is hyperemic.
4. Milk does not come out of the inflamed area and it is painful to feed. Inflamed ducts become swollen, preventing milk from coming out. Sometimes the outflow of milk is prevented by pus accumulating in the duct. When you attach the baby to the breast, the pain intensifies. That is, the milk arrives and tries to leave, but the way out is closed. So, the fluid expands the tissues and the pain intensifies.
5. The axillary lymph nodes are enlarged.
It is also important to know the symptoms of lactostasis
· Pain and hardness of the breast tissue, especially upon palpation.
· A network of dilated veins has appeared on the skin of the chest.
· Tension and soreness in areas of the mammary gland persist after emptying.
How is mastitis different from lactostasis?
It is very important for young mothers to understand the difference between normal stagnation of milk in the ducts and mastitis. Mastitis requires special treatment, and it is possible to get rid of stagnation on your own. During stagnation:
· the skin at the site of inflammation is not as bright red as with mastitis;
· There may be no fever or chills, and the pain is not as intense.
A clogged duct is also characterized by a painful compaction in the breast.
Before the temperature rises, you can fight stagnation on your own or by inviting a lactation consultant. If the elevated temperature lasts for 2 days, you cannot do without a doctor. The female breast is an extremely delicate organ, and the infection instantly covers it entirely.
Sometimes mastitis is an extreme degree of lactostasis. Remember - only a doctor can differentiate lactostasis and mastitis.
1. You should not abruptly wean your baby off the breast, as this can provoke another hormonal stress directly for your body. When breastfeeding, mastitis is not always a contraindication.
2. It is strictly forbidden to take drugs that suppress lactation, tighten the breasts, massage the breasts too harshly, or squeeze the affected areas. Fluid restriction is contraindicated because milk production must be stimulated and not suppressed.
4. Do not take antibiotics under any circumstances without a doctor’s prescription; if the temperature rises and persists, you cannot self-medicate – see a doctor immediately.
Treatment of mastitis
Regular pumping is extremely important, this process cannot be stopped, even if you are not breastfeeding or the baby does not have time to eat. Main condition successful therapy mastitis – simulation of milk outflow from the breast. Emptying the breasts reduces the load directly on the gland, which helps prevent the emergence of new foci of stagnation.
If the inflammatory process is chronic, the doctor is forced to prescribe a course of antibiotics. The choice of medications depends on the causative agent of the disease. When taking antibiotics, the child is transferred to formula feeding. Breastfeeding can be resumed after treatment is completed.
In order to improve milk flow, the doctor may prescribe an oxytocin solution. This helps relieve spasms in the breast.
If there is an external source of infection - cracks in the nipple or inflammation, applications with healing ointments Purelan, Bepanten, etc. are prescribed.
At temperatures above 38.50C, you need to take paracetamol-based products.
At the very beginning of the disease, you can use traditional medicine, but only together with the main treatment.
If mastitis is neglected (not treated), it may result in surgical intervention. No more than 2 days should pass from the first signs of the disease to a visit to the doctor. This time is enough to resolve lactostasis. With purulent mastitis and if the symptoms worsen, only a surgeon can help.
If you had surgery
After removing mastitis through surgical intervention there is a high probability that milk production has not stopped. But you should remember that after surgery, breastfeeding is not recommended for the first time, because... The woman is prescribed a course of antibiotics. Express milk approximately every 3 hours, and temporarily transfer the baby to artificial feeding.
It should be noted that there is a less pleasant scenario when milk from the operated breast is not expressed. In this case, the doctor will prescribe special medications to the mother that temporarily block lactation. At the same time, milk must be expressed regularly from a healthy breast. Due to the effects of the drugs, milk production will decrease in volume, but after some time everything will return to normal.
It is important not to forget: breastfeeding after surgery- This is a question that should be decided exclusively by the attending physician.
Prevention of mastitis
If you have a tendency to mastitis ( big breasts, many curved ducts, low immunity), then you need to take care to prevent milk stagnation. This is very important not only for the young mother, but also for the child, because... In the first six months of a baby’s life, breast milk is his main food.
Prevention methods:
· During the first birth, excess breast milk after feeding the baby must be expressed until relieved. There is no need to strive to express the mammary gland until it is “empty”; excessive zeal can lead to increased milk production. After a week or a week and a half, the woman’s body will understand that this amount of milk is not in demand, and it will reduce prolactin production.
· When breastfeeding, change positions so that the baby empties different lobules of the breast. In addition, changing position ensures uniform outflow.
· If cracks or abrasions appear on the nipples, be sure to treat them. Use attachments or wound healing ointments.
· Personal hygiene when breastfeeding is extremely important: to avoid infecting the gland, wear clean underwear. Drops of milk are a favorable breeding ground for bacteria. When washing your breasts, do not actively squeeze them or rub the nipples too hard; use soap with a neutral pH factor.
The main thing to remember: mastitis is not a contraindication to breastfeeding! The affected breast simply needs regular emptying of milk and the baby will do this most effectively. There is no need to be afraid that pathogenic bacteria will reach the newborn. As a rule, together with breast milk he receives the antibodies that the mother’s body produces. And no self-medication without consulting a doctor, because not only your health is at stake, but also the full development of your child!
The material was prepared by Natalya KOVALENKO. Website illustrations: © 2017 Thinkstock.
A disease of the mammary glands caused by staphylococci and other microbes that appears while a woman is breastfeeding is called lactation mastitis. It is also called postpartum mastitis. Bacterial infection breast pain can be caused by cracked nipples. But this is not the only reason: even if a woman does not have cracks in the nipple area, she can get mastitis, and the one who has cracks can remain healthy.
Inflammation of the mammary gland manifests itself as swelling of a particular area or the entire breast, pain, a feeling of fullness, high temperature. Breastfeeding a child with this disease is very painful, but necessary (unless antibiotics are prescribed). 
What causes inflammation, and how to minimize the damage from it, if it has already occurred - let's figure it out together.
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The disease is more typical for primiparous women; most often it occurs at the time of lactation, in the first weeks, when the young mother does not yet know how to properly handle lactating breasts. Often problems with the mammary glands arise during weaning. In both cases, the cause of the disease is hormonal and functional changes that the body has to cope with. The immune system, actively restructuring to work in a new way, does not have time to suppress the pathogenic flora. And microbes that are harmless under normal circumstances become the cause of mastitis. The microorganisms that cause this disease are streptococcus and Staphylococcus aureus.
Pathogens enter the mammary gland through microcracks in the nipples. During the period when breastfeeding begins, nipples often suffer from inept attachment, and during weaning they are rubbed with linen, etc. Microcracks contribute to the rapid spread of any inflammatory processes: ordinary breast thrush can provoke the spread of infection into the mammary gland.
More about the causes of mastitis
All causes of mastitis can be divided into several groups.
- Lactostasis. It leads to mastitis most often. A few days after the baby is born female body ready for the next important process - breastfeeding.
Instead of colostrum, the mammary gland begins to secrete milk. The first arrival of milk is often accompanied by some inconveniences for the mother: the breasts swell and hurt, diarrhea appears (milk should stimulate the passage of meconium in the newborn), milk may spontaneously leak. This is how the hormone prolactin works. The body does not yet “know” how much milk the baby will need, so the first milk supply is usually larger than the newborn needs. The baby does not have time to cope (or, in general, does not breastfeed), so there are frequent cases of stagnation of milk. 
- A sharp hormonal change in the beginning or end of breastfeeding is accompanied by a decrease in immune forces, so pathogens more easily overcome the protective barrier.
- Nipples are not ready for breastfeeding: the skin on the nipples is tender and thin. Due to errors in attachment and unfamiliarity with constant friction, nipples are easily injured and take a long time to heal, becoming a gateway for various microbes.
- Violation of hygiene requirements: breasts and nipples must be clean. If milk leaks, you should not leave it on the breast for a long time. Use breast pads, wash underwear and clothes, as the dairy environment is ideal for bacteria to multiply quickly.
- Excessive cooling of the mammary gland is a direct path to inflammation.
- Tumors of various origins inside the mammary gland.
What are the symptoms of mastitis?
- Fever up to 38 degrees or more. Chills, weakness, and a headache may appear. A blood test will show an increase in white blood cells.
- Soreness when touching the entire chest. It is also worth thinking about mastitis if only the areola of the breast or nipple becomes painful and swollen, if you can feel a lump in place of any duct with your hands.
- The skin in the place where there is a lump or lump is hyperemic.
- Milk does not drain from the inflamed area, and feeding is painful. The inflamed ducts become swollen and milk cannot come out of them. Sometimes the outflow of milk is interfered with by pus that accumulates in the duct. If you put the baby to the breast, the pain intensifies: the milk comes in and strives to come out, but the way out is closed. The fluid expands the tissues, increasing the pain.
- The axillary lymph nodes enlarge, actively producing defenders to fight microbes attacking the body.
It is important to understand the difference between mastitis and ordinary stagnation of milk in the ducts. Mastitis needs special treatment(including antibiotics), and you can get rid of stagnation yourself. During stagnation:
- the skin at the site of inflammation during stagnation is not as bright red as with mastitis;
- There may be no fever or chills, the pain is not so pronounced.
A clogged duct is also characterized by a painful compaction in the gland. Only a doctor can differentiate between lactostasis and mastitis. Sometimes mastitis is an extreme degree of lactostasis.
Problem Symptoms Body temperature What to pay attention to Engorgement of the mammary glands when milk comes in (usually 3-4 days after birth) and a change in the composition of milk on days 10-18 after birth Breasts become swollen, painful, hot and hard Can increase significantly when measured in armpit, in others the x-groin or elbow point is slightly elevated or normal If the baby cannot latch onto a tight breast well, it is recommended to express it a little before feeding. Lactostasis (duct blockage, milk stagnation) The place where the duct is blocked swells, a painful lumpiness appears, and redness of the skin is often observed. When expressing from a certain part of the nipple, milk does not flow or flows poorly Not increased Put your baby to your breast as often as possible. When feeding, choose a position so that the baby's chin is directed towards the seal. Pre-warming and massaging the painful area may help. Carry out the massage with gentle stroking movements, avoid strong squeezing. Uninfected mastitis Feeling worse, inflamed areas hurt, pain can be felt when walking, changing position Could be 38 degrees or higher If the breasts are emptied effectively, the condition improves within 24 hours. If there is no improvement, consult a doctor Before the temperature rises, you can fight stagnation on your own or by inviting a lactation consultant. If the temperature is elevated for 2 days, you cannot do without a doctor. The female breast is a very delicate organ, the infection covers it entirely instantly. Therefore, if you want to preserve not only lactation, but also the breasts themselves, be sure to consult a doctor for advice.
- At first, while there is only stagnation, you need to actively feed the baby with the sore breast. Trying to get his chin right where the seal is. Try to regularly offer your child exactly the diseased gland to help its ducts cleanse. Sucking stimulates the production of prolactin, that is, milk. The flow of fluid normalizes the activity of the edematous duct. If the baby does not take the breast, is worried, or cries, it means that milk is not flowing when sucking.
- After finishing feeding, you can put it on the bed for 10-15 minutes. sore spot, covered with a diaper, ice, which helps to narrow the ducts.
- Try pumping with your hands or a breast pump.
Manual pumping is a priority, since only hands can provide additional massage to the sore breast; hands are warm and more sensitive than mechanical suction. Choose a direction away from you, stroke the sore spot with force, stimulate the chest along the flow of lymph. If possible, pump the sore breast until empty. 
Try to “grope” where exactly the pain is localized, how the diseased duct passes through the chest. Take a position so that it is not pinched, but is straightened as much as possible (perhaps the milk will flow better in a supine position or in a knee-elbow position). Circular or stretching movements will help relieve the chest. Do not pull on the nipple, knead the body of the gland by running your fingers towards the nipple. Expressing movements from the edges of the breast to the nipple help the outflow of fluid. - You need to express your breasts every 2 hours, including at night.
- Entrust the care of your child to your family: right now their help is needed. Take care of your problem exclusively - a healthy mother who has milk is the most important thing, all household chores can wait.
- If there is no temperature, you can try to stimulate the entire breast with a warm (not hot!) shower so that the ducts are warm and ready for self-massage.
Express into a diaper to see what color your breast fluid is. If streaks of green, brown, yellow flowers– you are close to the goal: the duct has cleared. You need to express gently but persistently, regardless of the pain: you don’t want to go to the surgeon just because it was painful to express? If you express milk correctly, then after mastitis its quantity will even increase - frequent stimulation ensures the production of large doses of the milk hormone. 
When the lump in the breast is already large and the woman has a fever, the baby can only be applied to a healthy breast. You need to express milk from the inflamed gland without giving it to the baby.
If there are obvious purulent discharge, or an ultrasound has diagnosed purulent mastitis, the child should not be given milk even from a healthy breast, since the infection can spread through the bloodstream. In this case, breastfeeding can be restored only after a course of treatment and good test results.
Options for the location of abscesses in the mammary gland:
1 - subareolar; 2 - subcutaneous; 3 - intramammary; 4 - retromammary.4 prohibited actions for mastitis
You should not abruptly wean your baby, as this will provoke another hormonal stress for your body. With breastfeeding, mastitis is not always a contraindication for feeding a child.
Under no circumstances should you take any medications that suppress lactation, tighten your breasts, massage the gland too harshly, or put too much pressure on the affected areas. Fluid restriction is contraindicated because it is necessary to stimulate milk production, not suppress it.
It is forbidden to heat the area of inflammation: heating pads, baths, hot showers are prohibited.
Do not take antibiotics without a doctor's prescription, do not torture yourself folk remedies if the temperature rises.
Treatment of mastitis
If mastitis starts, it may result in surgery. No more than 2 days should pass from the first signs of illness to a visit to the doctor. This time is enough to resolve lactostasis. If the symptoms worsen or the temperature rises, medical intervention is necessary. With purulent mastitis, only a surgeon can help.
Incisions on the mammary gland depending on the location of abscesses in it:
1 - radial; 2 - semilunar on the lower transitional fold; 3 - semi-oval, bordering the areola of the nipple.Regular pumping is very important; you cannot stop this process, even if you do not give milk to your baby. Simulating the outflow of milk from the mammary glands is the main condition for successful treatment of mastitis. Emptying the breast reduces the load on the gland and helps prevent the appearance of new foci of stagnation. Sometimes, if the inflammatory process has acquired signs of chronicity, the doctor is forced to prescribe a course of antibiotics. Their choice depends on the causative agent of the disease. When taking antibiotics, a child is transferred to formula feeding. GV can be resumed after treatment is completed.
For temperatures above 38.5C, take paracetamol-based fever remedies.
Folk remedies
At the very beginning of the disease, along with the main treatment, you can alleviate your condition using traditional methods.
A cut leaf of cabbage, Kalanchoe or aloe is placed on the sore chest for 2 hours or more.
A compress made from mint, alder leaves, and burdock helps to facilitate pumping.
Prevention of mastitis If you think mastitis is coming on, don't panic. Lactostasis occurs quite often, mastitis is much less common. We strongly recommend that you actively pump, visit a doctor and maintain your guard so that your beloved baby does not suffer due to illness.
Video - Mastitis during breastfeeding: what to do?
- Lactostasis. It leads to mastitis most often. A few days after the baby is born female body ready for the next important process - breastfeeding.
