What is the management of periodic mastitis (inflammation of the breast)?

From the Guidelines

The management of periodic mastitis involves a combination of supportive care, antibiotics, and pain management, with the goal of reducing inflammation, pain, and preventing complications, as there is no specific evidence-based treatment for periodic mastitis, but general principles of mastitis management can be applied. The treatment approach should prioritize reducing morbidity, mortality, and improving quality of life.

• Initial management includes pain relief with analgesics such as ibuprofen 400mg three times daily or paracetamol 1g four times daily 1.
• Antibiotics may be considered if there is evidence of bacterial infection, but the choice of antibiotic and duration of treatment should be guided by local resistance patterns and clinical judgment.
• Supportive care measures such as warm compresses applied to the affected area for 15-20 minutes several times daily can help reduce inflammation and pain.
• Adequate breast support with a well-fitting bra is also important during the healing process.
• It is essential to note that breastfeeding can continue on the affected side as long as the infant’s mouth does not contact purulent material, and regular feeding or expression of milk is an adjunct to other treatment 1.
• In cases of abscess formation, ultrasound-guided aspiration or surgical incision and drainage may be necessary.
• Patients should be monitored for recurrence and advised on preventive measures, such as proper breast hygiene and avoiding tight-fitting clothing.
• The evidence from 1 and 1 suggests that a multidisciplinary approach to management, including supportive care, antibiotics, and pain management, can help reduce morbidity and improve quality of life for patients with periodic mastitis.

From the Research

Management of Periodic Mastitis

The management of periodic mastitis involves a combination of conservative measures and medical interventions.

• Conservative measures include nonsteroidal anti-inflammatory drugs, ice application, feeding the infant directly from the breast, and minimizing pumping 2.
• If there is no improvement in symptoms, narrow-spectrum antibiotics may be prescribed to cover common skin flora (e.g., Staphylococcus, Streptococcus) 2, 3.
• Obtaining milk cultures should be considered to guide antibiotic therapy, and ultrasonography should be performed to identify abscesses in immuno-compromised patients or those with worsening or recurrent symptoms 2.
• The use of osteopathic manipulative medicine has also been explored as a novel management approach for recurrent mastitis, with some studies showing promising results 4.
• Intralesional steroid injections have been used to manage granulomatous mastitis, with studies showing consistent evidence for their safety, efficacy, and low recurrence rate 5.

Prevention of Mastitis

Prevention of mastitis is crucial, and the best prevention is a proper lactation technique, including a good infant latch, and encouraging physiologic breastfeeding rather than pumping, if possible 2.

• Factors that increase the risk of mastitis include overstimulation of milk production and tissue trauma from aggressive breast massage 2.
• Frequent overfeeding, excessive pumping to empty the breast, heat application, and breast massage are no longer recommended because they may worsen the condition 2.

Treatment Outcomes

The treatment outcomes for mastitis vary depending on the severity of the condition and the effectiveness of the treatment approach.

• Studies have shown that most patients can be treated as outpatients with oral antibiotics, but if the condition worsens or there is a concern for sepsis, intravenous antibiotics and hospital admission may be required 2, 6.
• The use of probiotics for treatment or prevention of mastitis is not supported by good evidence 2.