Introduction
Mastitis is the medical term to denote inflammation of the breasts. As sensitive and tender the organ is, such bad are the pain and sufferings caused to the patient by the inflammation of the same. It usually affects breastfeeding women in their twenties or older but rare cases are reported in teenagers with obesity, diabetes etc. Acute mastitis is caused by germs including bacteria that spread from outside environment. Clogged or blocked capillaries and tubules facilitate the inflammation along with redness, swelling, severe pain and tenderness. The pain can be so severe and sickening. Even wearing a dress over chest may be unbearable. Immediate intervention is needed in such cases to relieve pain and to prevent spread of infection.
Signs & symptom
Acute Signs and symptoms of mastitis include:
- Pain and tenderness of breast tenderness
- Warm touch of breast
- Swelling of breast
- Hardening of breast tissue/breast lump
- Pain or a burning sensation continuously or while breast-feeding
- Wedge-shaped redness on breast
- Generally feeling sick
- High fever
Causes
Most common cause of mastitis is breastmilk trapped in the breast.
Other conditions include:
- Bacteria entering your breast.Bacteria from skin’s surface and baby’s mouth can enter the milk ducts through a crack in the skin of nipple or through a milk duct opening. Stagnant milk in a breast that isn’t emptied provides a breeding ground for the bacteria.
Risk factors for mastitis include:
- Previous bout of mastitis while breast-feeding
- Sore or cracked nipples — although mastitis can develop without broken skin
- Wearing a tightfitting bra or putting pressure on your breast when using a seat belt or carrying a heavy bag, which may restrict milk flow
- Improper nursing technique
- Becoming overly tired or stressed
- Poor nutrition
- Smoking
Pathophysiology
While understanding the specialities of anatomy, each breast has a number of sections (lobules) that branch out from the nipple. Each lobule holds tiny, hollow sacs (alveoli). The lobules are linked by a network of thin tubes (ducts). If a woman is breast-feeding, ducts carry milk from the alveoli toward the dark area of skin in the centre of the breast (areola). From the areola, the ducts join together into larger ducts ending at the nipple. The term mastitis, as explained earlier, denotes an inflammation in the breast tissue or capillaries. It can happen in multiple ways like:
In lactational mastitis, the source of infection is bacteria, mostly from the mouth of baby while feeding. They enter through cracks or fissures in the nipple surface. Once the primary defences are breached, organisms have an ideal culture environment in nutrient rich maternal milk leading to rapid cell division and growth. This can be augmented by milk stasis and overproduction leading to mastitis. In neonates, transient breast enlargement secondary to maternal hormones can make them vulnerable to mastitis.
In duct ectasia, the mammary duct-associated inflammatory disease sequence involves squamous metaplasia of lactiferous ducts, causing blockage (obstructive mastopathy) with peri-ductal inflammation and possible duct rupture. Inflamed ducts are prone to bacterial infection.
In tubercular mastitis, mycobacterium tuberculosis can enter the breast from a direct inoculation (via a nipple abrasion) or more commonly from secondary spread from a distal source such as lymphatic spread, miliary dissemination, or contiguous spread (e.g., empyema necessitans). Clinical presentation is usually of a solitary, ill-defined, unilateral hard lump situated in the upper outer quadrant of the breast. Primary TB of the breast is rare. Necrotizing granulomas are the histopathological hallmark of TB infection.
In granulomatous mastitis, granulomas are usually non-necrotizing, inflammation is focused around breast lobules that clinically may present as a painless mass.
Diagnosis
- A thorough physical exam
- A culture of breast milk
- A mammogram or ultrasound or both to rule out inflammatory breast cancer. A rare form of carcinoma of the breast called inflammatory breast cancer also show similar signs & symptoms.
- A biopsy in needed cases.
Treatments
- Mastitis treatment includes:
- Antibiotics – In an infection, a 10-day course of antibiotics is usually needed. It’s important to take all of the medication to minimize the chance of recurrence.
- Pain relievers – such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).
It is safe to continue breast-feeding if you have mastitis. Breast-feeding actually helps clear the infection. Weaning your baby abruptly is likely to worsen your signs and symptoms.
Guidance to ensure proper and safe breastfeeding
- Avoiding prolonged overfilling of your breast with milk before breast-feeding.
- Trying to ensure that your infant latches on correctly — which can be difficult when your breast is engorged. Expressing a small amount of milk by hand before breast-feeding might help.
- Massaging the breast while breast-feeding or pumping, from the affected area down toward the nipple.
- Making sure your breast drains completely during breast-feeding. If you have trouble emptying a portion of your breast, apply warm and moist heat to the breast before breast-feeding or pumping milk.
- Breast-feeding on the affected side first, when your infant is hungrier and sucking more strongly.
- Varying your breast-feeding positions.
Prognosis
When treated promptly, most of breast infections heal quickly, without serious complications. Most women can continue to breastfeed despite an episode of uncomplicated mastitis.
Complications
Abscess formation and pus discharge
Rarely carcinoma of breast
Disease & Ayurveda
Sthanaroga – sopha
Nidana
Stagnant milk
Improper breastfeeding
Food and regimen causing vitiation of doshas, especially kapha & Pitta
Purvaaroopa
Not mentioned
Samprapti
Due to causative factors vitiated doshas predominantly kapha causes swelling and obstruction of channels in breast. After that, when Pitta is associated Paaka (inflammation) happens. In the blocked channels, deviated Vaata causes pain and tenderness. These three doshas when vitiated, get lodged in the breast of lactating woman affects rakta&maamsa dhatu and lead to disease manifestation.
Lakshana
- Pain
- Tenderness
- Hardness on touch
- Heaviness of breasts
- Mild fever
- Warmth, discoloration or smell of discharge from breast/breastmilk
Divisions
Not mentioned.
Prognosis
Sadhyam in navam and Apaakai (new and without inflammation)
Krischrasadhyam in puraanam and Paaki(chronic and inflammatory)
Chikithsa
Samana
Lepanam with Rookshana dravyas
Swedanam
Vimlapanam
Sodhana
Paatanam
Vidaaranam
Then treatment of wound should be done
Commonly used medicines
Guggulupanchapalachoornam
Kanchanaraguggulu
Varasanadi kashayam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Some home remedies help reduce the discomfort:
- Avoid prolonged overfilling of your breast with milk before breast-feeding
- Apply cool compresses or ice packs to your breast after breast-feeding
- Wear a supportive bra
- Rest as much as possible
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from very hot climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles