Mastitis and Breast Abscess

What it is

Mastitis is inflammation of the breast, most often caused by a bacterial infection during breastfeeding, when accumulated milk and cracked nipples make it easier for bacteria to enter. The breast becomes red, warm, hardened and painful, with fever and malaise. Outside of breastfeeding, mastitis can be linked to smoking, duct ectasia, piercings or rare inflammatory diseases. Without treatment, it can progress to an abscess — a collection of pus that needs to be drained. Diagnosis is clinical, with ultrasound when an abscess is suspected. Treatment includes antibiotics, pain relievers, adequate emptying of the breast (breastfeeding should generally continue) and, in the case of an abscess, drainage by ultrasound-guided puncture or surgery, depending on the size.

Most common symptoms

• Red, warm, hardened and painful area of the breast
• Fever, chills and malaise, similar to the flu
• Pain that worsens during or after breastfeeding
• Cracks or sores on the nipple
• Fluctuant, very painful lump, suggesting an abscess
• Enlarged, tender lymph nodes in the armpit
• Pus draining from the nipple or the skin, in advanced cases

Causes and risk factors

• Milk buildup from spaced-out feedings, poor latch or rapid weaning
• Nipple cracks, which open a path for bacteria
• Skin bacteria, especially staphylococcus
• Smoking and duct ectasia, in mastitis unrelated to breastfeeding
• Nipple piercing, diabetes and low immunity
• Rare inflammatory breast diseases, such as granulomatous mastitis

How it is diagnosed

The diagnosis is clinical: the history of pain, redness and fever, often during breastfeeding, combined with a breast exam, is usually enough to start treatment. When there is a very painful lump, ultrasound, performed on site, checks for a collection of pus and guides drainage. The discharge can be sent for culture in cases that do not respond to antibiotics. When the inflammation persists despite treatment or occurs outside of breastfeeding, mammography and biopsy rule out other causes.

How we treat it at Femi Saúde

Treatment begins early, with antibiotics and pain relievers, and with adequate emptying of the breast: during breastfeeding, the usual guidance is to continue feedings or pumping, correcting the latch and any cracks, since stagnant milk feeds the inflammation. The breast health team at Femi Saúde monitors the response over a few days and, when there is an abscess, performs drainage by ultrasound-guided puncture at the clinic, repeated if necessary; larger collections or those with compromised skin may require surgical drainage. In mastitis unrelated to breastfeeding, investigating the cause, such as smoking and duct ectasia, guides prevention of new episodes. The plan is individualized for each case.

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