Symptoms of Mastitis in Lactating Women
Mastitis presents with a characteristic triad of fever, focal breast pain, and overlying skin erythema or hyperpigmentation, typically occurring within the first 3 months postpartum. 1
Core Clinical Presentation
The diagnosis of mastitis is made clinically based on the following symptoms:
- Fever - A systemic sign that frequently accompanies mastitis 1, 2
- Malaise - General feeling of unwellness and systemic symptoms are common 1, 3
- Focal breast tenderness - Localized pain in the affected area of the breast 1
- Overlying skin erythema or hyperpigmentation - Visible redness or darkening of the skin over the inflamed area 1
- Swollen, hot breast - The affected breast becomes edematous and warm to touch 2
Timing and Onset
- Rapid onset - Symptoms typically develop fairly quickly 4
- Early postpartum period - Usually occurs within the first few months of delivery, most commonly in the first 3 months 4, 1
Additional Clinical Features
- Painful swelling - The breast becomes increasingly painful and swollen 3
- Nipple fissures or trauma - May be present and can serve as a portal of entry for infection 3
- Unilateral presentation - Mastitis typically affects one breast, though bilateral cases can occur 2
Important Clinical Context
The diagnosis does not require laboratory tests or imaging in straightforward cases - the clinical presentation alone is sufficient for diagnosis. 1 However, milk cultures should be considered to guide antibiotic therapy if symptoms don't improve with conservative measures, and ultrasonography should be performed in immunocompromised patients or those with worsening or recurrent symptoms to identify potential abscess formation. 1
Critical Pitfall to Avoid
A history of being diagnosed with "mastitis" that has not responded to at least 1 week of antibiotics should raise concern for inflammatory breast cancer, which can mimic mastitis with erythema, pain, and skin changes. 4 This is a rare but important differential diagnosis that must not be missed.