bubble_chart Overview

It mostly occurs postpartum and is most common in primiparas. It is often caused by staphylococcal infection, resulting from blocked milk ducts and milk stasis, where bacteria directly invade. Alternatively, bacteria may enter through cracks in the nipple or areola, invading the milk ducts and spreading along the lymphatic drainage to infect the mammary lobules.

bubble_chart Etiology

Apart from the overall decline in anti-infection ability postpartum, there are two main reasons:

1. Milk stasis. Milk stasis provides a favorable environment for the growth and reproduction of invading bacteria. The causes of stasis include: ① Poor nipple development (too small or inward invasion) hindering breastfeeding; ② Excessive milk production or insufficient infant suckling, leading to incomplete milk drainage; ③ Blocked milk ducts, affecting milk discharge.

2. Bacterial invasion. Nipple damage allowing bacteria to invade along the lymphatic vessels is the primary route of infection. Infants sleeping with the nipple in their mouth or infants with stomatitis also facilitate direct bacterial invasion of the milk ducts. The predominant pathogenic bacteria are Staphylococcus aureus.

bubble_chart Clinical Manifestations

At the onset, systemic toxic symptoms such as high fever and chills are often present. The affected breast increases in size, becomes locally hardened, with reddened skin, tenderness, and throbbing pain. If the area softens within a short period, it indicates the formation of an abscess, requiring incision and drainage. The axillary lymph nodes on the affected side are often swollen, and the white blood cell count is elevated.

The clinical manifestations of an abscess are related to its depth. When superficial, there is early local redness, swelling, and bulging, whereas deep abscesses often show minimal local signs early on, with local pain and systemic symptoms being predominant. Abscesses may be single or multiple; they may form sequentially or simultaneously; sometimes they rupture spontaneously or discharge through the nipple, or they may invade the loose tissue in the retromammary space, forming a retromammary abscess (Figure 1).

Figure 1 Location of breast abscess.

bubble_chart Diagnosis

1. History of nipple trauma or poor nipple development, initially presenting with chills followed by high fever, shiver, headache, breast distending pain or throbbing pain.

2. Early breast swelling with localized induration, progressing to redness, swelling, heat, and tenderness; abscess formation may lead to fluctuance, and superficial infections may rupture spontaneously; ipsilateral axillary lymphadenopathy and tenderness.

3. Systemic manifestations include loss of appetite, elevated body temperature, shiver, and possible sepsis.

4. Laboratory findings show a significant increase in total white blood cell count and neutrophils.

bubble_chart Treatment Measures

1. Early-stage treatment involves rest, suspending breastfeeding on the affected side, cleaning the nipple and areola, and promoting milk excretion (using a breast pump or suction). For cases requiring incision and drainage, breastfeeding should be terminated.

2. Apply local 25% magnesium sulfate dampness-heat compresses or physical therapy.

3. In the early stage, penicillin (800,000–1,000,000 U) mixed with 1–2% procaine (10 ml) dissolved in 10–20 ml of isotonic saline can be injected around the mass for local blockade.

4. Systemic antibiotics should be administered. To prevent severe infection and sepsis, antibiotics should be selected based on bacterial culture and sensitivity tests, with intravenous drip administration if necessary.

5. Chinese medicinals for clearing heat and removing toxin.

6. For formed abscesses, timely incision and drainage are required. The incision is generally radial with the nipple and areola as the center. For superficial subareolar abscesses, an arc-shaped incision along the areola can be made. For abscesses located behind the breast, an arc-shaped incision should be made 1–2 cm below the skin fold of the lower breast. {|105|}

bubble_chart Prevention

Prevention of mastitis is more important than treatment. During pregnancy and lactation, it is essential to keep both nipples clean. If there is nipple inversion, gently pull out the nipple and clean it thoroughly. Before and after breastfeeding, wash the nipples with a 3% boric acid solution. Develop a habit of breastfeeding at regular intervals, ensuring that the milk is fully expressed each time. If the milk cannot be fully expressed, use massage or a breast pump to remove it. If the nipple is already damaged or cracked, temporarily stop breastfeeding and use a breast pump to express milk until the wound heals before resuming breastfeeding.