Symptoms of Mastitis
Mastitis presents clinically with focal breast tenderness, overlying skin erythema or hyperpigmentation, fever, and malaise—diagnosis is made on these clinical findings alone without requiring laboratory tests or imaging in most cases. 1
Core Clinical Presentation
The hallmark symptoms of mastitis include:
- Focal breast tenderness in one breast, typically unilateral 1, 2
- Fever accompanying the breast symptoms 1, 2
- Malaise or general feeling of unwellness 1, 2
- Overlying skin erythema or hyperpigmentation at the affected area 1
- Warmth over the affected breast tissue 3
- Swelling of the affected breast area 3
Timing and Context
- Lactational mastitis most commonly occurs in the first 3 months postpartum, affecting approximately 10% of breastfeeding mothers in the United States 1, 2
- Symptoms typically develop in breastfeeding women but can occur at any age, including in males and during pregnancy (antepartum mastitis) 4, 5
Important Clinical Distinctions
The diagnosis is made clinically based on the presence of these symptoms without the need for laboratory tests or imaging in straightforward cases. 1 However, certain situations warrant additional evaluation:
- Obtain milk cultures to guide antibiotic therapy if treatment is needed 1
- Perform ultrasonography in immunocompromised patients or those with worsening or recurrent symptoms to identify abscess formation 1
- Consider follow-up imaging in non-puerperal women (especially middle-aged or older) to exclude associated malignancy, as mastitis can mask pre-existing breast cancer 3
Critical Pitfall to Avoid
When non-puerperal women present with inflammatory breast signs, persistent or growing palpability after recovery of inflammation should prompt percutaneous core biopsy and short-term ultrasonographic follow-up to exclude associated malignancy, as mastitis can mask underlying breast cancer. 3