Mastitis or mastitis is an inflammation or infection of the breast that can cause severe swelling and pain, often accompanied by fever. The infection is often caused or accompanied by inflammation of the affected nipple .

Mastitis can be caused, for example, by micro-injuries and the penetration of bacterial pathogens . Other causes can be hormone fluctuations , allergic reactions or pathological tissue changes.

Both women and men can get nipple infections. However, breastfeeding mothers are most often affected at the beginning of their breastfeeding period.

causes

The nipple (mamille) with the adjacent areola (areola) and the mammary glands (mammae) present in the female body is a sensitive body region due to the numerous nerve tracts ending here. Breasts and nipples sometimes react very sensitively to external or internal body-related irritations.

Since breast or nipple inflammation occurs most frequently, but not exclusively, in breastfeeding mothers, a distinction is made in the following text between breastfeeding-related mastitis and those nipple inflammations that can be traced back to other causes.

Causes related to breastfeeding:

When lactation occurs soon after birth or when there has been a long interval between feeds, one or both breasts may become overfull and swollen. Usually, this uncomfortable condition quickly subsides as the baby feeds. For various reasons, however, breast engorgement can also occur, in which individual areas of the breast become hard and painful.

Reasons for this can be, for example, too long feeding breaks, psychological or physical impairments of the milk flow reflex or injuries to the breast or nipple. If germs multiply in the accumulated milk in the case of a breast engorgement, which have spread through a sore nipple or through the bloodstream in the body, breast inflammation occurs through the formation of a painful abscess (pus focus). This inflammation then often leads to inflammation of the nipple in question.

Other causes:

Injuries ( abrasions or cuts ) to the breast or nipple can also lead to bacterial infections in men. Bleeding or inflamed nipples are particularly common among long-distance runners. Due to the frequent training and without the use of supporting functional underwear as women do, the textiles rub against the sensitive nipples and thus cause irritation and even inflammation.

Another cause that affects not only women but also men of advanced age is hormonal changes. During menopause , the reduction in testosterone production leads to an increase in estrogen levels in the male blood, which can also cause changes in the nipples and nipples. Other changes in hormone levels, e.g. B. during puberty or cycle-related hormone fluctuations in women before menstruation or during the menopause are often the cause of tension, pain and inflammation.

Furthermore, inflammation of the nipples can be caused by allergies or general intolerance to certain substances or chemicals (detergents, fabric softeners, cosmetics). Tumors in the breast tissue are one of the serious causes of nipple inflammation, although fortunately they are rather rare.

Symptoms, Ailments & Signs

Since the nipple is very sensitive, irritations show up early on in the form of redness, pain and increased sensitivity to pressure. Nipple inflammation can occur on one or both sides, depending on the cause. The pain can radiate to the entire chest, which is then tense and hot and feels extremely painful when pressure is applied.

The transition to the infection stage is indicated by a fever of mostly over 39°, which can be accompanied by a general feeling of weakness , chills , sometimes also vomiting and flu-like body aches . Breastfeeding mothers can also experience changes in the appearance of the breast milk secretion (bloody or purulent), crusting or discharge.

Other symptoms may include the formation of a purulent and palpable abscess or swelling of the affected lymph nodes . Incidentally, there can also be a non-breastfeeding-related discharge of secretions with partial blood or pus components from the mammary gland . In any case, it is advisable to consult a doctor.

complications

The transition between engorgement and breast inflammation in breastfeeding women or nipple and breast inflammation for other reasons is fluid. True mastitis is a dangerous complication that requires antibiotic treatment. Abscesses are considered a complication that, if not treated early, can worsen to the point where surgery is the only way to improve.

When should you go to the doctor?

Breastfeeding mothers should consult a midwife or lactation consultant immediately if they experience engorgement or difficulties breastfeeding. Complications as serious as abscesses can often be prevented by acting quickly and vigorously. In any case, you should continue breastfeeding.

If there is no improvement within 24 hours, the indication of an antibiotic should be discussed with a doctor. In general, it can also be said for non-breastfeeding-related nipple infections: If there is fever and worsening of the pain, the progression of the infection should be prevented by a doctor.

A doctor should also be consulted if you are unsure about changes in the shape or color of the nipples or if unclear secretion occurs or if you feel lumps or abscesses, since malignant, carcinoma changes in breast tissue can also be accompanied by such symptoms.

Diagnose

Regardless of whether the nipple inflammation occurred as a side effect of breastfeeding or due to other causes, the treating doctor, midwife or lactation consultant will first scan the affected breast after a patient consultation and, if necessary, also examine it with an ultrasound .

Abscesses and hardening can be detected quickly. If the secreted secretion is conspicuous, a smear is taken and examined in a laboratory for pathogens and blood. However, if the problem is suspected to be within the female milk ducts, a so-called galactography can be performed. Here, a contrast medium is introduced into the milk ducts using a probe in order to be able to show and examine them in detail on an X-ray image.

Other invasive and non-invasive examination methods can then be used to confirm the diagnosis, for example mammography is one of the most common examinations of the breast. In this way, any tumors can also be detected comparatively reliably. This examination method is therefore also standard for women over 40 in the context of the early detection of breast cancer .

If the examination reveals a suspicious lump or thickening, this change can be examined using a tissue biopsy. In case of doubt and if there is a suspicion of a further illness, a blood and hormone test can provide additional information.

Treatment & Therapy

Since there are different causes for a nipple infection, a specific treatment is also recommended.

In the case of engorgement and problems with breastfeeding, for example, cooling and gentle measures are often sufficient to bring about rapid improvement. If in doubt, the measures should be discussed with a midwife or lactation consultant. Depending on the problems that occur, cold is recommended to relieve pain and contain the inflammation and heat to dilate the vessels.

For example, ice packs or cool compresses can be applied between breastfeeding periods. In acute cases, home remedies are also said to achieve very good results, such as chilled cabbage leaves, which, when applied, quickly reduce the swelling and curb milk production somewhat. Quark or honey compresses or poultices with Retterspitz can also reduce the inflammation more quickly. In any case, breastfeeding should continue!

Not only mother and child benefit from a longer breastfeeding relationship, the measure also helps the milk drain well and prevents the inflammation from getting worse. If those affected are open to homeopathic treatment , Phytolacca Cl 2 or Nux vomica 6 CH may help with engorgement, while Belladonna 6 CH, Hepar sulfur 6 CH or Silicea 6 CH may help with breast inflammation. Bach flowers can also be used for relief, for example aspen, larch, mustard or crab apple.

If the nipple is particularly affected, herbal ointments can quickly provide relief. Preparations with ingredients such as wool wax and marigold ointment have shown the fastest improvements here. If there is no obvious improvement after treatment, drug treatment with antibiotics may be indicated.

In the worst case, if an abscess does not go away in any other way, only surgical measures can help. The pus abscess is opened as part of a small operation so that the pus can drain.

Outlook & Forecast

In the case of a nipple infection – especially in the case of diseases caused by breastfeeding – literally every minute counts. The earlier an impending inflammation is recognized and the earlier the therapeutic measures are started, the faster an improvement can be observed.

For example, if breast engorgement has been successfully removed, inflammation of breast tissue can be prevented in most cases. If an infection does occur, the home or herbal remedies described usually help within a few days. If antibiotics are administered, a few weeks should be sufficient for the inflammation and side effects to heal successfully and completely.

The prognosis for untreated inflammation, on the other hand, is rather poor. The formation of purulent abscesses through to hardening, skin rashes or, in rare cases, malignant tumors required comparatively lengthy therapy, which often also necessitated surgical intervention.

prevention

Even before breastfeeding, you can prevent breast and nipple infections. It has been observed that heat helps effectively here. You can either place a warm, damp cloth on your chest or simply take a warm shower more often. A tip among midwives is a potato wrap shortly before breastfeeding.

To do this, wrap warm jacket potatoes in a kitchen towel, crush them and place the towel around the breast in question. Alternatively, poultices made from powdered fenugreek seeds mixed with hot water to a pulp can help. Like potatoes, this seed contains an anti-inflammatory component and prevents the breast tissue from becoming inflamed in the first place.

During the breastfeeding period, strict attention should generally be paid to hygiene. It is therefore advisable to change the nursing pads regularly. The right breastfeeding technique also has a decisive influence on the good drainage of the milk. A midwife or lactation consultant will be happy to help and advise you. The costs for postpartum care are usually borne by the health insurance company. You should therefore consult a midwife early on and while you are still pregnant.

In order to prevent inflammation of the nipple due to allergic reactions, you should pay attention to skin irritations after changing cosmetics or detergents and, if necessary, replace them. The same applies when wearing certain fabrics or textiles. Many people complain of skin irritation when using synthetic fabrics. It often helps to wear a garment made of natural fibers under the synthetic garment. To prevent bleeding and sore nipples from chafing, endurance athletes should cover their nipples with a plaster before training and competitions.

aftercare

After a nipple infection, it is essential to take follow-up measures. Otherwise it will quickly come back to inflammation. The earlier you recognize the signs, the easier it is to avoid a painful infection. If the nipple inflammation occurs more frequently during breastfeeding, it is advisable to change the breastfeeding method and breastfeed more often.

During the breaks in breastfeeding, you can treat the sensitive skin areas either with cold to relieve and reduce swelling, or with heat to expand the vessels and promote blood circulation. Old household remedies such as cold quark wraps or warm potato compresses are suitable for this. Herbal ointments such as calendula ointment have also proven to be good preventatives.

If the nipple inflammation is caused by an allergy, you should change detergents and cleaning agents and possibly investigate the causes of intolerance to certain cotton blends. A different, hypoallergenic detergent or changing the cotton content of tops is often sufficient to completely prevent recurring nipple infections.

Athletes can wear functional underwear to prevent the textiles from rubbing against their skin or mask sensitive areas with plasters before training. Medical follow-up after a nipple infection is usually not required. However, if you observe the preventive measures, further infection can be avoided or usually alleviated without antibiotic treatment.

You can do that yourself

Especially with nipple inflammation caused by breastfeeding, you can help yourself as a sufferer. Above all, you should rest. Life with a baby initially turns everything upside down and demands a lot from the young mother’s body and mind. It often helps to simply lie in bed with the child for a day or two and calm down.

The designation of the first weeks after the birth as “postpartum” makes the profound change in everyday life clear in terms of language. At the very least, you should try to slow down a little for at least a few days. Midwives often recommend keeping the breast empty if you are having trouble breastfeeding. If necessary, it should be breastfed at least every one to two hours so that the breast in question does not fill up too much. If only one side is affected, the child should always latch on to that side first to ensure it is emptied.

The right breastfeeding technique is also important. If anything is unclear or you have questions, a midwife should help you put it on and during breastfeeding. For breastfeeding mothers, it is generally advisable to avoid incisive and constricting clothing. Psychological insecurities and problems are often behind breastfeeding problems. In this sensitive situation, it is therefore particularly important to talk to a lactation consultant or midwife.