Physical Examination Findings in Mastitis
On physical examination of a lactating woman with breast pain and swelling, you would expect to find localized erythema, warmth, tenderness, and induration of the affected breast tissue, often accompanied by systemic symptoms such as fever and malaise. 1
Characteristic Physical Findings
Local Breast Findings
- Erythema (redness): Focal area of redness over the affected segment of the breast 2
- Edema (swelling): Noticeable swelling of the affected area 1
- Warmth: Increased temperature of the skin over the affected area compared to surrounding tissue
- Tenderness: Focal breast tenderness upon palpation 2
- Induration: Firm, hardened area of breast tissue in the affected region
- Possible palpable mass: May feel like a firm, tender area within the breast tissue 3
Systemic Findings
- Fever: Often present (typically >38.5°C/101.3°F)
- Malaise: General feeling of unwellness
- Flu-like symptoms: Including body aches and fatigue 4
Distinguishing Features from Other Conditions
Mastitis vs. Breast Engorgement
- Mastitis: Unilateral, focal involvement with marked erythema and tenderness
- Engorgement: Usually bilateral, diffuse swelling without significant erythema
Mastitis vs. Breast Abscess
- Mastitis: Diffuse inflammation without fluctuance
- Abscess: Fluctuant mass with more severe symptoms, may have pointing or skin discoloration 4
Mastitis vs. Inflammatory Breast Cancer
- Mastitis: Acute onset, responds to antibiotics within 48-72 hours
- Inflammatory breast cancer: Persistent symptoms despite antibiotics, may have skin changes like peau d'orange (skin dimpling resembling orange peel) 2
Clinical Pearls
- Lactational mastitis typically occurs within the first 3 months postpartum, with symptoms developing rapidly over 24 hours 1
- The left breast is not more commonly affected than the right; either breast can develop mastitis 4
- Continued breastfeeding from the affected breast is recommended and generally does not pose a risk to the infant 4
- If symptoms do not improve within 48 hours of antibiotic therapy, consider ultrasonography to evaluate for abscess formation 1
Warning Signs of Complications
- Worsening symptoms despite 48 hours of appropriate antibiotic therapy
- Development of fluctuance or pointing, suggesting abscess formation
- Systemic signs of sepsis including hypotension, tachycardia, or altered mental status
- Persistent symptoms beyond 7-10 days, which may indicate resistant organisms or non-infectious etiology 5
Remember that early recognition and appropriate management of mastitis is crucial to prevent complications such as abscess formation and to support continued breastfeeding, which has significant health benefits for both mother and infant.