1. Mastitis in Breastfeeding
Russell W. Lake, MD CPT MC USA Dept. of Family Medicine
Eisenhower Army Medical Center

2. Mastitis in Breastfeeding
“Painful inflammation of the breast occurring in conjunction with flu-like symptoms (e.g., fever, malaise)”
Diagnosis
Clinical
Culture rarely used to confirm bacterial infection
Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6):

3. Mastitis in Breastfeeding
Incidence
1-3% of lactating women
9.5% up to 33% of breastfeeding women
Most common in 2nd and 3rd weeks postpartum
75-95% of cases occur before infant is 12 weeks old
Right and left breasts affected equally
Hopkinson J and Schanler RJ. Common problems of breastfeeding in the postpartum period. Up to Date. Updated February 5, 2009.
Department of Child and Adolescent Health and Development. Mastitis: causes and management. Geneva, Switzerland: World Health Organization; Accessed June 15, 2009.
Foxman B, D'Arcy H, Gillespie B, Bobo JK, Schwartz K. Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 2002;155(2):
Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6):

4. Mastitis in Breastfeeding
Risk factors
Cleft lip or palate
Previous mastitis
Cracked nipples
Primiparity†
Infant attachment difficulties
Restriction from a tight bra
Local milk stasis
Short frenulum in infant
Missed feeding
Sore nipples
Nipple piercing*
Use of a manual breast pump
Plastic-backed breast pads
Yeast infection
Poor maternal nutrition
*outside of pregnancy †inconsistently demonstrated
Causes
MRSA
Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6):

5. Mastitis in Breastfeeding
Differential diagnosis
Plugged milk duct(s)
Abscess
Inflammatory breast cancer
Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6):

6. Mastitis in Breastfeeding
Management
Continued breast feeding; “Pump & dump” if infant dislikes taste
Warm compresses
Supportive care, NSAIDs
Antibiotic initiation and duration poorly studied
Antibiotics
Amoxicillin/clavulanate
875mg BID
Cephalexin
500mg QID
Ciprofloxacin
500mg BID
Clindamycin
300mg QID
Trimethoprim/Sulfamethoxazole*
160mg/800mg BID
Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6):

7. Mastitis in Breastfeeding
Complications
Breast abscess in 5-11% of women with mastitis
Cessation of breastfeeding
Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6):

8. Mastitis in Breastfeeding
Prevention
Optimization of breast feeding techniques
Lactation consultant
Bedside hand disinfection
Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6):
Peters F, Flick-Filliés D. Hand disinfection to prevent puerperal mastitis. Lancet. 1991;338(8770):831.

9. References
Department of Child and Adolescent Health and Development. Mastitis: causes and management. Geneva, Switzerland: World Health Organization; Accessed June 15, 2009.
Foxman B, D'Arcy H, Gillespie B, Bobo JK, Schwartz K. Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 2002;155(2):
Hopkinson J and Schanler RJ. Common problems of breastfeeding in the postpartum period. Up to Date. Updated February 5, 2009.
Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6):