bubble_chart Overview

Puerperal mastitis often occurs after the first childbirth and can be classified into two types based on the progression of the disease: stagnant mastitis and suppurative mastitis.

bubble_chart Clinical Manifestations

(1) Stasis Mastitis: Occurs in the puerperium initial stage [first stage] (usually around 1 week postpartum). Due to the lack of breastfeeding experience in primiparas, milk stasis is prone to occur, caused by failure to empty the breasts on time. Patients experience varying degrees of distending pain in both breasts, along with moderate fever (around 38.5°C). Examination reveals breast fullness, slight surface redness (congestion), and tenderness. However, symptoms often resolve after milk is expressed, so it is generally not considered true mastitis. Nevertheless, if deficient in timely management, or if the nipple is small and forcefully broken by the newborn, stagnant milk can become contaminated by pyogenic bacteria. Therefore, excess milk must be emptied, and nipple cleanliness should be maintained.

(2) Suppurative Mastitis: Mostly caused by staphylococci or streptococci infecting through cracked nipples. As mentioned earlier, postpartum milk stasis, if deficient in timely emptying, can easily lead to infection. After bacteria invade the mammary ducts, they continue to spread into the parenchyma, forming various types of suppurative mastitis.

1. Inflammation spreads to superficial lymphatics, leading to erysipelas-like lymphangitis. Patients suddenly develop high fever, often accompanied by shivering, breast tenderness, and localized red spots or streaks on the skin, which are characteristic of this type.

2. Inflammation is confined to the connective tissue around the areola, forming a subareolar abscess.

3. Infection spreads along lymphatics into the mammary interstitium, extending from the surface to the base, traversing the breast tissue. Suppuration of connective tissue leads to interstitial abscess formation. Such abscesses may be confined to a single mammary lobule or spread to most of the breast.

4. Infection spreads rapidly, deeply reaching the loose connective tissue between the breast base and the pectoralis major muscle, forming a retromammary abscess.

The site of inflammation or abscess presents with redness, swelling, and tenderness. Fluctuation can be felt upon palpation of the abscess. If necessary, a diagnostic puncture may be performed to aspirate pus for bacteriological examination and drug sensitivity testing, providing reference for antibiotic selection.

bubble_chart Treatment Measures

Treatment should be determined based on the inflammatory condition. Generally, when there is nipple rhagade, breastfeeding should be stopped. After local cleaning with 3% boric acid solution, apply cod liver oil bismuth or compound formula benzoin acid tincture. If there is no nipple rhagade, breastfeeding can still be continued during the initial stage [first stage] of mastitis. If there is milk stasis, gentle local tuina or using the back edge of a wooden comb to gently comb toward the nipple can help clear the blockage, along with local cold compresses. If inflammation is evident, breastfeeding should be stopped, and the milk should be expressed. Support the breast with a bandage, apply local hot compresses, and administer a closed injection into the retro-mammary tissue with 60ml of 0.25% procaine mixed with 400,000U of penicillin, once daily, along with oral or intramuscular antibiotics.

For those who have developed an abscess, due to the unique anatomical structure of the breast, the extent of breast tissue damage is much more severe than what surface examination might indicate. For more severe cases, it is advisable to perform incision and drainage in the operating room under general anesthesia. The incision should consider cosmetic outcomes and avoid cutting the mammary ducts. For retro-mammary abscesses or deep abscesses on the lower side of the breast, a curved incision should be made along the breast base line. A finger should be inserted into the abscess cavity to break the septa of multiple small compartments, connecting them into one. The pus should be sent for bacterial culture, and a rubber tube or strip should be inserted for drainage, or the cavity should be tightly packed with sterile Vaseline gauze. Cover with sterile dressing and apply pressure bandaging to reduce wound bleeding. After two or three days, remove the drainage strip and change the dressing, continuing antibiotic treatment for 7–10 days.