General surgery mastitis. Mastitis. Classification, clinic, treatment. Which doctor treats mastitis

27. Mastitis

Mastitis is a purulent-inflammatory disease of the breast tissue. The most common microorganisms (causative agents of this process) are staphylococci, streptococci, synegus bacillus.

The penetration of the infectious agent occurs through cracks in the nipple (most often) or milk ducts. The hematogenous route of infection is extremely rare.

Introduced, microorganisms receive a favorable environment for growth and reproduction, serous inflammation occurs. It is the initial stage of the process and can be reversible even with conservative treatment.

Subsequently, leukocytes begin to migrate to the focus, an increase in vascular permeability leads to the release of the liquid part of the blood into the tissue - exudate. These changes indicate the successively emerging infiltrative and suppurative stages of purulent inflammation of the mammary gland.

By localization, suareolar mastitis is distinguished, while the focus of inflammation is located around the areola, retromammary - inflammation is localized in the retromammary space, intramammary - the focus of inflammation is located directly in the breast tissue.

The disease develops sharply. The first symptoms are associated with galactostasis and include intense bursting pains, mainly in one mammary gland. There is a violation of milk secretion from this gland, it increases in size, becomes denser.

The general well-being of a woman is deteriorating.

Complaints of a general nature appear, including the appearance of fever, chills, most often worsening in the evening, decreased performance, appetite, and sleep disturbance.

In the general analysis of blood, an increase in the erythrocyte sedimentation rate (ESR), the appearance of leukocytosis with a shift of the leukocyte formula to the left are noted. When examining the patient, an increase in one mammary gland in volume, local redness and hyperemia are noted. When a focal point of suppuration appears in the mammary gland, the general condition of patients worsens significantly, fever can take on a hectic nature, and general complaints are expressed. On examination, the presence of a focus of redness is noted in the mammary gland, over which softening (fluctuation) is determined.

Surgical treatment includes opening and draining the lesion. Depending on the localization of inflammation, para-areolar, radial incisions and an incision along the transitional fold of the mammary gland are distinguished. The abscess is washed, exudate is removed, all leaks are cleared, its cavity is sanitized, drainages are installed.

Common treatments include strict no feeding during illness (but milk must be expressed) and drugs that suppress lactation.

When verifying the causative agent of the disease, antibiotic therapy is carried out, antibiotics are administered intravenously. Depending on the severity of the disease, detoxification therapy, vitamin therapy, and correction of water-electrolyte metabolism are sometimes indicated.

From the book Healing Power in Your Hands the author

From the book Tips of a Hereditary Healer the author Larisa Alekseeva

Mastitis 1. From herbs, celandine helps well here. The most succulent parts of the plant are the leaves. They should be finely cut and squeezed out in any way convenient for you. You need to lubricate the cracked nipples and wait a while for the juice to be absorbed. This must be done many times with

From the book Blue iodine - and the disease will go away the author Nina A. Bashkirtseva

Mastitis Mastitis is an inflammation of the breast that occurs during lactation. The disease develops as a result of blockage of the ducts of the mammary gland. The cause is insufficient emptying of the milk ducts when feeding the baby.

From the book Healer. Folk ways. the author Nikolay Ivanovich Maznev

Mastitis Mastitis (breast) is an inflammation of the breast. Usually occurs when nipple cracks are present, usually in breastfeeding women.

From the book Home Homeopathy the author

Mastitis For sore nipple cracks, give Arnica 3 and Silicea 6 after 2 hours. After feeding, wash the nipples with warm Calendula water (a tablespoon of tincture in a glass of warm water) and, after drying the breast, grease with butter. For redness and inflammation, give Belladonna 3

From the book Homeopathic Reference the author Sergey Alexandrovich Nikitin

Mastitis Pale, hot, hard, heavy, painful breasts, Briony. Great soreness and tenderness of breasts; the patient cannot bear the shaking of the bed; when walking should support breasts - varnish

From the book Home Directory of Diseases the author Ya.V. Vasilieva (comp.)

From the book of Celandine. The best remedy for 250 diseases the author Yuri Mikhailovich Konstantinov

Mastitis Juice is lubricated with cracked nipples, giving 2-3 minutes for the juice to penetrate inside the patient

From the book Official and ethnoscience... The most detailed encyclopedia the author Genrikh Nikolaevich Uzhegov

Mastitis A method of treating inflammation breast: liberally lubricate the nipple cracks and the breast itself 3-4 times at intervals of 2-3 minutes in an hour or two. You can take 1 tablespoon orally, diluted with water, 10-15 minutes before meals 3 times

From the book Sauerkraut, onion peel, horseradish. Simple and affordable recipes for health and beauty the author Yulia Nikolaevna Nikolaeva

Mastitis Mastitis (breast) is an inflammation of the breast. It is observed mainly in nursing mothers, more often in primiparous. Sometimes adolescents during puberty develop the so-called juvenile mastitis. In old age, mastitis often develops in women who do not

From the book Healing Aloe the author

Mastitis (breastfeeding) Mastitis is an inflammation of the breast. It usually occurs due to cracked nipples in nursing mothers. The mammary gland swells, becomes dense, tight and very painful. The skin around the nipple turns red and shiny. There is an increase

From the book Diseases from A to Z. Traditional and Alternative Treatment the author Vladislav Gennadievich Liflyandsky

Mastitis In case of mastitis, to accelerate the maturation of abscesses and abscesses, crush an aloe leaf, apply it to the sore spot and tie it. The dressing should be changed as much as possible

From the book Beekeeping Products. Natural medicines the author Yuri Konstantinov

From the book Ginger. Well of health and longevity the author Nikolay Illarionovich Danikov

Mastitis Use a white wax patch: 30 g wax, 60 g olive oil, 120 g spermacet. Melt everything over low heat, stirring with a wooden spoon until a homogeneous mass is obtained, then remove from heat and mix until it cools. After applying the mixture to a canvas, apply to

From the author's book

Mastitis Podmor is also used to treat mastitis, mastopathy and varicose veins. The recipe consists in steaming 200 grams of bees in boiling water and infusing for half an hour. The steam obtained in this way is then slightly squeezed out and through a dense

From the author's book

Mastitis, or breastfeeding? Mix 2: 1 gruel from baked onion onion and ginger honey. Apply the mixture 2-3 times a day for 3-4 hours daily until complete recovery.? Boil the pumpkin pulp in a small amount of milk until a thick gruel is obtained. In the received

Mastitis is an inflammatory process in the tissues of the breast. It is manifested by severe bursting pain in the chest, swelling, induration, reddening of the skin of the gland, a sharp rise in body temperature, chills. Mastitis is diagnosed by visual examination by a mammologist, in addition, an ultrasound of the mammary gland is possible. The disease can lead to the formation of an abscess, abscess, phlegmon, necrosis in the mammary gland, the development of sepsis and even death. In case of microbial contamination of milk, breastfeeding will have to be stopped. In the long term, deformity of the mammary gland may occur, and the risk of developing mastopathy and breast cancer increases.

General information

Inflammation of the breast tissue. Mastitis is caused by bacteria in the breast. It is manifested by swelling of the gland, an increase in size, soreness and increased sensitivity, redness of the skin and an increase in temperature.

The incidence of mastitis among nursing mothers ranges from 1% to 16% depending on the region. On average, this figure is 5% of lactating women, and measures to reduce the incidence over the past years have so far been ineffective. The vast majority (85%) of women with mastitis are primiparous (or breastfeeding for the first time). This is due to the higher incidence of milk stagnation due to inept expression. Women over thirty, who are not breastfeeding for the first time, develop mastitis, as a rule, as a result of reduced protective properties of the body in connection with one or another concomitant chronic disease. In such cases, the symptoms of mastitis are accompanied by clinical manifestations of the underlying disease.

Causes of mastitis

Most often, mastitis is caused by a staphylococcal infection. But with a source of bacterial flora available in a woman's body (infection respiratory system, oral cavity, urinary tract, genitals) mastitis can be caused by her. Sometimes the mammary gland becomes infected with Escherichia coli. Bacteria enter the mammary gland through the bloodstream and through the milk ducts.

Most often, mastitis develops as a result of prolonged pathological lactostasis (stagnation of milk in the gland). With a prolonged absence of milk outflow from any area of the mammary gland, a favorable environment for the reproduction of bacteria is formed there, the developing infection provokes an inflammatory reaction, fever, suppuration.

Classification of mastitis

Mastitis is distinguished by the nature of the existing inflammatory process: serous, infiltrative, purulent, abscess, gangrenous and phlegmonous mastitis. Serous, infiltrative and purulent mastitis are successive stages of the inflammatory process in the gland tissue from the formation of a swollen area of serous inflammation, to the formation of an infiltrate and the development of a purulent process.

With abscessed mastitis, the purulent focus is localized and limited, phlegmonous mastitis is characterized by the spread of purulent inflammation along the tissue of the gland. With a prolonged course or weakened body defenses, the inflamed tissues of the gland become necrotic (gangrenous mastitis). Allocate clinical types mastitis: The most common are acute postpartum mastitis, plasma cell mastitis, and neonatal mastitis.

Symptoms of mastitis

Acute postpartum mastitis is most often an inflammatory complication of lactostasis in nursing mothers. Sometimes develops without precedence pronounced signs stagnation of milk. It is manifested by the appearance of a painful compaction in the mammary gland, redness and an increase in skin temperature in the area of compaction, fever and general symptoms of intoxication. As the pain progresses, the pain increases, the chest increases, it becomes hot to the touch. Feeding and pumping is extremely painful, and blood and pus can be found in the milk. Purulent mastitis often progresses with the development of a breast abscess.

Plasma cell mastitis is rare disease, which develops in older women who have repeatedly given birth after cessation of lactation. It is characterized by infiltration of tissues under the nipple by plasma cells and hyperplasia of the epithelium of the excretory ducts. Such mastitis does not suppurate and has some external features in common with breast cancer.

Mastitis of newborns is a fairly common condition in children of both sexes, manifested by swelling of the mammary glands, discharge when pressed on them (as a rule, it is the result of the residual action of the mother's sex hormones). With the development of acute purulent inflammation and the formation of an abscess, surgical debridement of the purulent focus is performed, but most often the symptoms subside after three to four days.

Diagnosis of mastitis

The focus of inflammation in the mammary gland is determined by palpation. There is also an increase (sometimes moderate pain on palpation) of the axillary lymph nodes from the side of the affected breast. Suppuration is characterized by the definition of a fluctuation symptom.

If mastitis is detected at the stage of serous inflammation or infiltration, conservative treatment of mastitis is carried out. Antibiotic therapy is prescribed with the use of potent agents. wide range actions. In this case, serous mastitis, as a rule, disappears after 2-3 days; it may take up to 7 days for the infiltrate to dissolve. If inflammation is accompanied by severe general intoxication, detoxification measures are carried out (infusion of electrolyte solutions, glucose). With pronounced excess lactation, agents are prescribed to suppress it.

Purulent forms of mastitis usually require surgery. The developed abscess of the mammary gland is an indication for emergency surgical debridement: opening the mastitis and draining the purulent focus.

Progressive mastitis, regardless of its stage, is a contraindication to further feeding (including healthy breast), since breast milk is usually infected and contains toxic tissue debris. For a child, pathologically altered breast milk can cause the development of dysbiosis and disorders of the functional state of the digestive system. Since mastitis therapy includes antibiotics, breastfeeding during this period is also not safe for the infant. Antibiotics can markedly damage the normal development and growth of organs and tissues. During the treatment of mastitis, milk can be expressed, pasteurized and only then given to the child.

Indications for suppression of lactation: lack of dynamics in serous and infiltrative mastitis within three days of antibiotic therapy, development of a purulent form, concentration of an inflammatory focus directly under the nipple, existing purulent mastitis in the mother's history, concomitant pathologies of organs and systems that significantly worsen the general well-being of the mother.

Prevention of mastitis

Measures for the prevention of mastitis coincide with those for the prevention of lactostasis, since this condition is a precursor of mastitis in the vast majority of cases.

To prevent milk stagnation, a complete thorough emptying of the mammary glands is necessary: regular feeding and subsequent expression of the remaining milk. If a baby eats milk from one breast, in the next feeding it is first applied to the gland that was untouched the last time.

Do not let your baby just suck on the breast to calm it down, without sucking the milk out. Cracks in the nipples contribute to the development of inflammation of the mammary gland, therefore it is necessary to prepare the nipples for feeding, carefully observe hygiene rules (clean hands, breasts), correctly apply the baby to the breast (the child must grip the entire nipple with his mouth, along with the areola).

One of preventive measures the development of mastitis can be called the timely identification and rehabilitation of foci of infection in the body, but it is worth remembering that the total antibiotic therapy contraindicated during lactation.

Acute mastitis- inflammation of the mammary glands. The disease can be acute or chronic. Mastitis usually develops in one mammary gland; bilateral mastitis occurs in 10% of cases. Postpartum mastitis in lactating women accounts for about 80-90% of all acute mastitis diseases.

Etiology and pathogenesis... The causative agents of mastitis are usually staphylococcus, staphylococcus in combination with Escherichia coli, streptococcus, very rarely Proteus, Pseudomonas aeruginosa, Candida-type fungi. Nosocomial infection is of paramount importance. The entrance gates are cracks in the nipples, ducts (when expressing milk, feeding). The infection can spread to the gland by hematogenous or lymphogenous from other infectious foci. Disorders of milk outflow contribute to the development of the disease.

Distinguish the following development phases acute mastitis: serous, infiltrative and abscessed. In the phase of serous inflammation, the tissue of the gland is saturated with serous fluid, an accumulation of leukocytes is noted around the vessels, which is characteristic of a local reaction to inflammation. With the progression of the inflammatory process, serous impregnation is replaced by diffuse purulent infiltration of the parenchyma of the mammary gland with small foci of purulent fusion, which, merging, form abscesses. The multiple and gangrenous forms of mastitis are particularly severe. By localization, abscesses are divided into subcutaneous, subareolar, intramammary, retromammary.

Clinical picture and diagnostics... Acute mastitis begins with pain and engorgement of the mammary gland, a rise in body temperature. As the disease progresses, the pain intensifies, the swelling of the mammary gland increases, painful foci of dense infiltrated tissue are clearly defined in it, and skin hyperemia appears. Axillary The lymph nodes become painful and increase in size, body temperature rises, chills appear. The blood reveals leukocytosis, increased ESR. The transition of the serous form of mastitis to infiltrative and purulent occurs quickly - within 4-5 days. An extremely serious condition of patients is observed with multiple abscesses, phlegmonous and gangrenous mastitis. It is caused by the transition of a local reaction controlled by the immune system into a severe systemic reaction to inflammation syndrome, in which control immune system weakens. In this regard, signs characteristic of a severe syndrome of a systemic reaction to inflammation appear - an increase in body temperature to 39 ° C and above, the pulse increases to 100-130 per minute, the respiratory rate increases, the mammary gland becomes sharply painful, and increases in volume. The skin over the foci of inflammation is hyperemic, areas of cyanosis and epidermal detachment appear. In the blood, there is a pronounced leukocytosis with a shift of the leukocyte formula to the left, when sowing blood, it is sometimes possible to isolate bacteria. Protein is determined in the urine. Against this background, fatal multiple organ failure often develops.

Treatment... In the initial period of acute mastitis, conservative treatment is used: an elevated position of the mammary gland, milk suction by a breast pump. Before determining the causative agents of infection, antibiotic therapy with drugs of a wide spectrum of action is indicated. After bacteriological isolation of the pathogen, drugs are prescribed taking into account the sensitivity of the microflora. In parallel with this, intensive care to correct metabolic shifts. For any form of mastitis, breastfeeding is stopped so as not to infect the baby. Milk expressed from a healthy breast of a woman is used for feeding a child only after pasteurization.

After the mastitis is cured, milk is sown several times. In the absence of microflora growth, it is allowed to restore breastfeeding. In severe acute mastitis, suppression of lactation is shown. Prescribe drugs that inhibit the secretion of prolactin: bromocriptine (parlodel), a combination of estrogens with androgens; limit fluid intake. Tight bandaging of the chest is inappropriate. An indication for suppressing lactation is rapidly progressive mastitis, especially purulent (phlegmonous, gangrenous).

With abscess purulent mastitis surgical treatment is necessary - opening the abscess, removing pus, dissecting the bridges between the purulent cavities, removing all non-viable tissues, good drainage with double-lumen tubes for subsequent washing of the purulent cavity.

The operation is performed under general anesthesia. Only with small subcutaneous abscesses is it possible to use local anesthesia. Depending on the location of the abscess, the incision is made over the site of greatest compaction or fluctuation. With subcutaneous and intramammary abscesses, a radial incision is made, with near-areolar abscesses - arcuate along the edge of the areola. With a retromammary abscess, the Bardengeier incision along the lower transitional fold of the mammary gland provides optimal opportunities for opening a retromammary abscess and closely located abscesses in the gland tissue, excising non-viable tissues and draining the retromammary space, while it becomes possible to open deeply located abscesses in the posterior parts of the mammary gland adjacent to chest wall... During the operation, pus and all necrotic tissues are removed and bridges and leaks are eliminated. The abscess cavity is washed with an antibacterial solution and drained with one or two double-lumen tubes, through which the cavity is subsequently washed. Drainage purulent wounds single lumen tube, designed for passive outflow of pus, does not provide sufficient drainage. The use of a single-lumen tube, as well as tampons, rubber graduates and a puncture method of treatment should be abandoned, since it is not possible to carry out a full-fledged sanitation of the purulent cavity.

Mastitis in the old days it was called a breast. This pathology is an infectious and inflammatory process in the tissues of the breast, usually with a tendency to spread, which can lead to purulent destruction of the body of the gland and surrounding tissues, as well as to the generalization of infection with the development of sepsis (blood poisoning).

Distinguish between lactational (that is, associated with the production of milk by the gland) and non-lactational mastitis.
According to statistics, 90-95% of mastitis cases occur in the postpartum period. Moreover, 80-85% develops in the first month after childbirth.

Mastitis is the most common purulent-inflammatory complication of the postpartum period. The incidence of lactational mastitis is about 3 to 7% (according to some sources, up to 20%) of all births and does not tend to decrease over the past several decades.

Most often, mastitis develops in lactating women after the birth of their first child. Usually, the infectious and inflammatory process affects one gland, more often the right. The predominance of lesions on the right breast is due to the fact that it is more convenient for right-handers to express the left breast, so that milk stagnation often develops in the right.

Recently, there has been a trend towards an increase in the number of cases of bilateral mastitis. Today, a bilateral process develops in 10% of cases of mastitis.

About 7-9% of lactational mastitis are cases of inflammation of the mammary gland in women who refuse to breastfeed, in pregnant women this disease is relatively rare (up to 1%).

Cases of the development of lactational mastitis in newborn girls are described, during a period when an increased level of hormones from the mother's blood causes physiological swelling of the mammary glands.

About 5% of mastitis in women is not associated with pregnancy and childbirth. Typically, non-lactational mastitis develops in women between the ages of 15 and 60. In such cases, the disease proceeds less violently, complications in the form of generalization of the process are extremely rare, but there is a tendency towards a transition to a chronically recurrent form.

Causes of mastitis

Inflammation in mastitis is caused by a purulent infection, mainly Staphylococcus aureus. This microorganism causes various suppurative processes in humans from local skin lesions (acne, boils, carbuncles, etc.) to deadly damage to internal organs (osteomyelitis, pneumonia, meningitis, etc.).

Any suppurative process caused by Staphylococcus aureus can be complicated by generalization with the development of septic endocarditis, sepsis or infectious toxic shock.

Recently, cases of mastitis caused by the association of microorganisms have become more frequent. The most common combination Staphylococcus aureus with gram-negative Escherichia coli (common in environment microorganism that normally populates the human intestine).
Lactational mastitis
In those cases when it comes to the classic postpartum lactation mastitis, the source of infection is most often hidden bacteria carriers from medical personnel, relatives or roommates (according to some reports, about 20-40% of people are carriers of Staphylococcus aureus). Infection occurs through contaminated care items, linen, etc.

In addition, a newborn infected with staphylococcus can become a source of infection for mastitis, for example, with pyoderma (pustular skin lesions) or in the case of umbilical sepsis.

However, it should be noted that the ingress of Staphylococcus aureus on the skin of the mammary gland does not always lead to the development of mastitis. For the occurrence of an infectious-inflammatory process, it is necessary to have favorable conditions - local anatomical and systemic functional.

So, local anatomical predisposing factors include:

gross cicatricial changes in the gland remaining after severe forms of mastitis, operations for benign neoplasms, etc.;
congenital anatomical defects (inverted flat or lobular nipple, etc.).

As for the systemic functional factors contributing to the development of purulent mastitis, first of all, the following conditions should be noted:

pathology of pregnancy (late pregnancy, premature birth, threat of termination of pregnancy, severe late toxicosis);
pathology of childbirth (trauma to the birth canal, the first birth with a large fetus, manual separation of the placenta, severe blood loss during childbirth);
postpartum fever;
exacerbation of concomitant diseases;
insomnia and other psychological disorders after childbirth.

Primiparas are at risk of developing mastitis due to the fact that they have poorly developed glandular tissue producing milk, there is a physiological imperfection of the gland ducts, and the nipple is underdeveloped. In addition, it is significant that these mothers lack experience in feeding their babies and do not develop the skills to express milk.
Non-lactation mastitis
It develops, as a rule, against the background of a decrease in general immunity (transferred viral infections, severe concomitant diseases, sudden hypothermia, physical and mental stress, etc.), often after microtraumas of the breast.

The causative agent of non-lactational mastitis, as well as mastitis associated with pregnancy and feeding, in most cases is Staphylococcus aureus.

To understand the features of the mechanism of development of lactational and non-lactational mastitis, it is necessary to have a general understanding of the anatomy and physiology of the mammary glands.

Anatomy and physiology of the mammary glands

The mammary (breast) gland is an organ of the reproductive system designed for the production of human milk in the postpartum period. This secretory organ is located inside a formation called the breast.

In the mammary gland, a glandular body is isolated, surrounded by a well-developed subcutaneous fatty tissue. It is the development of the fat capsule that determines the shape and size of the breast.

On the most prominent place of the breast, there is no fat layer - the nipple is located here, which, as a rule, is conical, less often cylindrical or pear-shaped.

The pigmented areola forms the base of the nipple. In medicine, it is customary to divide the mammary gland into four areas - quadrants, limited by conditional mutually perpendicular lines.

This division is widely used in surgery to indicate localization. pathological process in the mammary gland.

The glandular body consists of 15-20 radially located lobes, separated from each other by a fibrous connective tissue and loose adipose tissue. The bulk of the actual glandular tissue producing milk is located in the posterior regions of the gland, while ducts prevail in the central regions.

From the front surface of the body of the gland through the superficial fascia, which limits the fatty capsule of the gland, to the deep layers of the skin and to the clavicle, dense connective tissue cords are directed, which are a continuation of the interlobar connective tissue stroma - the so-called Cooper's ligaments.

The main structural unit of the mammary gland is the acinus, consisting of the smallest formations of vesicles - alveoli, which open into the alveolar passages. The inner epithelial lining of the acinus produces milk during lactation.

The acini are united into lobules, from which the milky ducts depart, merging radially towards the nipple, so that the individual lobules are combined into one lobe with the common collecting duct. The collecting ducts open at the apex of the nipple, forming an expansion - the milk sinus.

Lactational mastitis is less favorable than any other purulent surgical infection, this is due to the following features of the anatomical and functional structure of the gland during lactation:

lobular structure;
a large number of natural cavities (alveoli and sinuses);
developed network of milk and lymphatic ducts;
an abundance of loose fatty tissue.

The infectious and inflammatory process with mastitis is characterized by rapid development with a tendency to the rapid spread of infection to neighboring areas of the gland, the involvement of surrounding tissues in the process and a pronounced risk of generalization of the process.

So, without adequate treatment, the purulent process quickly captures the entire gland and often takes a protracted chronic recurrent course. In severe cases, purulent fusion of large areas of the gland and the development of septic complications (infectious-toxic shock, blood poisoning, septic endocarditis, etc.) are possible.

The mechanism of development of the infectious and inflammatory process

The mechanism of development of lactational and non-lactational mastitis has some differences. In 85% of cases lactational mastitis the disease develops against the background of milk stagnation. In this case, lactostasis, as a rule, does not exceed 3-4 days.

Acute lactation mastitis

With regular and full expression of milk, bacteria that inevitably get on the surface of the mammary gland are washed out and are not able to cause inflammation.

In cases where adequate expression does not occur, a large number of microorganisms accumulate in the ducts, which cause lactic acid fermentation and milk coagulation, as well as damage to the epithelium of the excretory ducts.

Curdled milk, together with particles of desquamated epithelium, clog the milk ducts, resulting in lactostasis. Quite quickly, the amount of microflora, intensively multiplying in a confined space, reaches a critical level, and infectious inflammation develops. At this stage, secondary lymph congestion occurs and venous blood, which further aggravates the condition.

The inflammatory process is accompanied by severe pain, which in turn makes it difficult to express milk and aggravates the state of lactostasis, so that a vicious circle is formed: lactostasis increases inflammation, inflammation enhances lactostasis.

In 15% of women, purulent mastitis develops against the background of nipple cracks. Such damage occurs due to a mismatch between the sufficiently strong negative pressure in the child's oral cavity and the weak elasticity of the nipple tissue. Purely hygienic factors, such as prolonged contact of the nipple with the wet tissue of the bra, can play a significant role in the formation of cracks. In such cases, irritation and weeping of the skin often develop.

The appearance of cracks often forces a woman to refuse to feed the child and thoroughly expressing, which causes lactostasis and the development of purulent mastitis.

To avoid damaging the nipple while feeding, it is very important to latch the baby to the breast at the same time. In such cases, the correct biorhythm of milk production is established, so that the mammary glands are, as it were, prepared for feeding in advance: there is an increase in milk production, the milk ducts expand, the lobules of the gland contract - all this contributes to the easy release of milk during the feeding process.

With irregular feeding, the functional activity of the glands increases already during the feeding process, as a result, individual lobules of the gland will not be emptied completely and lactostasis will occur in certain areas. In addition, when the breast is not ready, the baby has to spend more effort during sucking, which contributes to the formation of cracks in the nipple.

Non-lactation mastitis

At non-lactational mastitis the infection usually enters the gland through damaged skin due to accidental injury, thermal injury(heating pad, tissue burn in case of an accident) or mastitis develops as a complication of local pustular skin lesions. In such cases, the infection spreads through the subcutaneous fatty tissue and the fatty capsule of the gland, and the glandular tissue itself is damaged again.

(Non-lactational mastitis, which has arisen as a complication of a breast boil).

Symptoms and signs of mastitis

Serous stage (form) of mastitis

The initial or serous stage of mastitis is often difficult to distinguish from the banal lactostasis. With stagnation of milk, women complain of heaviness and tension in the affected breast, in one or several lobes, a moderately mobile painful lump with clear segmental boundaries.

Expression with lactostasis is painful, but milk flows freely. The general condition of the woman is not disturbed and the body temperature remains within the normal range.

As a rule, lactostasis is a temporary phenomenon, therefore, if within 1-2 days the seal does not decrease in volume and a persistent subfebrile condition appears (an increase in body temperature to 37-38 degrees Celsius), then serous mastitis should be suspected.

In some cases, serous mastitis develops rapidly: completely unexpectedly, the temperature rises to 38-39 degrees Celsius, complaints of general weakness and pain in the affected section of the gland appear. Expressing milk is severely painful and does not bring relief.

At this stage, the tissue of the affected part of the gland is impregnated with serous fluid (hence the name of the form of inflammation), into which leukocytes (cells that fight against foreign agents) enter from the bloodstream a little later.

At the stage of serous inflammation, spontaneous recovery is still possible, when the pain in the gland gradually subside, and the seal is completely absorbed. However, much more often the process passes into the next - infiltrative phase.

Given the severity of the disease, doctors advise any significant engorgement of the mammary glands, accompanied by an increase in body temperature, to be considered the initial stage of mastitis.

Infiltrative stage (form) of mastitis

The infiltrative stage of mastitis is characterized by the formation of a painful seal in the affected gland - an infiltrate that has no clear boundaries. The affected mammary gland is enlarged, but the skin over the infiltrate at this stage remains unchanged (redness, local temperature increase and edema are absent).

The increased temperature in the serous and infiltrative stages of mastitis is associated with the entry of breast milk from the foci of lactostasis through the damaged milk ducts into the bloodstream. Therefore, at effective treatment lactostasis and desensitizing therapy, the temperature can be reduced to 37-37.5 degrees Celsius.

In the absence of adequate treatment, the infiltrative stage of mastitis turns into a destructive phase after 4-5 days. In this case, serous inflammation is replaced by purulent, so that the tissue of the gland resembles a sponge soaked in pus or a honeycomb.

Destructive forms of mastitis or purulent mastitis

Clinically, the onset of the destructive stage of mastitis is manifested by a sharp deterioration in the general condition of the patient, which is associated with the flow of toxins from the focus of purulent inflammation into the blood.

The body temperature rises significantly (38-40 degrees Celsius and above), weakness appears, headache, sleep worsens, appetite decreases.

The affected breast is enlarged and tense. In this case, the skin over the affected area turns red, skin veins expand, and regional (axillary) lymph nodes often increase and become sore.

Abscess mastitis characterized by the formation in the affected gland of cavities filled with pus (abscesses). In such cases, softening is felt in the area of the infiltrate, in 99% of patients the symptom of fluctuation is positive (a feeling of overflowing liquid when feeling the affected area).

(Localization of abscesses with abscessed mastitis:
1. - subalveolar (near the nipple);
2. - intramammary (inside the gland);
3. - subcutaneous;
4.- retromammary (behind the gland)

Infiltrative-abscessing mastitis, as a rule, is more severe than abscess. This form is characterized by the presence of a dense infiltrate, consisting of many small abscesses of various shapes and sizes. Since the abscesses inside the infiltrate do not reach large sizes, the painful induration in the affected gland may appear homogeneous (the fluctuation symptom is positive in only 5% of patients).

In about half of patients, the infiltrate occupies at least two quadrants of the gland and is located intramammary.

Phlegmonous mastitis characterized by a total increase and pronounced swelling of the mammary gland. In this case, the skin of the affected breast is tense, intensely red, in places with a cyanotic tint (cyanotic-red), the nipple is often retracted.

Palpation of the gland is sharply painful, in most patients a symptom of fluctuation is expressed. In 60% of cases, at least 3 quadrants of the gland are involved in the process.

As a rule, violations in laboratory blood parameters are more pronounced: in addition to an increase in the number of leukocytes, a significant decrease in the level of hemoglobin is observed. Indicators are significantly violated general analysis urine.

Gangrenous mastitis develops, as a rule, due to involvement in the process blood vessels and the formation of blood clots in them. In such cases, as a result of a gross violation of blood supply, necrosis of significant areas of the breast occurs.

Clinically, gangrenous mastitis is manifested by an enlargement of the gland and the appearance on its surface of areas of tissue necrosis and blisters filled with hemorrhagic fluid (ichor). All quadrants of the mammary gland are involved in the inflammatory process, the skin of the breast acquires a bluish-purple appearance.

The general condition of the patients in such cases is severe, confusion of consciousness is often observed, the pulse quickens, the blood pressure drops. Many laboratory parameters of blood and urine tests are violated.

Diagnosis of mastitis

If you suspect breast inflammation, you should seek the help of a surgeon. In relatively mild cases, nursing mothers can consult an attending antenatal clinic.

As a rule, the diagnosis of mastitis is not particularly difficult. The diagnosis is determined on the basis of the characteristic complaints of the patient and the examination data of the affected breast.
From laboratory tests, as a rule, they carry out:

bacteriological examination of milk from both glands (qualitative and quantitative determination of microbial bodies in 1 ml of milk);
cytological examination of milk (counting the number of erythrocytes in milk as markers of the inflammatory process);
determination of milk pH, reductase activity, etc.

In destructive forms of mastitis, an ultrasound examination of the mammary gland is shown, which makes it possible to determine the exact localization of areas of purulent fusion of the gland and the state of the surrounding tissues.
With abscessed and phlegmonous forms of mastitis, the infiltrate is punctured with a needle with a wide lumen, followed by bacteriological examination pus.

In disputable cases, which often arise in the case of chronic course process appoint X-ray examination breast (mammography).

In addition, in chronic mastitis, it is imperative to carry out differential diagnostics with breast cancer; for this, a biopsy (collection of suspicious material) and histological examination are performed.

Treatment of mastitis

Indications for surgery are destructive forms of the infectious and inflammatory process in the mammary gland (abscess, infiltrative-abscess, phlegmonous and gangrenous mastitis).

The diagnosis of a destructive process can be unambiguously made in the presence of softening foci in the mammary gland and / or a positive symptom of fluctuation. These signs, as a rule, are combined with a violation of the general condition of the patient.

However, erased forms of destructive processes in the mammary gland are often found, and, for example, with infiltrative-abscessed mastitis, it is difficult to identify the presence of foci of softening.

Diagnosis is complicated by the fact that banal lactostasis often occurs with a violation of the general condition of the patient and severe soreness of the affected breast. Meanwhile, as practice shows, the question of the need surgical treatment should be resolved as soon as possible.

In controversial cases, to determine the medical tactics, first of all, a thorough expression of milk from the affected breast is carried out, and then, 3-4 hours later, a repeated examination and palpation of the infiltrate.

In those cases when it was only about lactostasis, after expressing the pain subsides, the temperature decreases and the general condition of the patient improves. In the affected area, fine-grained painless lobules begin to palpate.

If lactostasis was combined with mastitis, then even 4 hours after expression, a dense painful infiltrate continues to be palpated, the body temperature remains high, the condition does not improve.

Conservative treatment mastitis is acceptable when:

the general condition of the patient is relatively satisfactory;
the duration of the disease does not exceed three days;
body temperature below 37.5 degrees Celsius;
absent local symptoms purulent inflammation;
soreness in the area of infiltration is moderate, palpable infiltration occupies no more than one quadrant of the gland;
indicators of a general blood test are normal.

If conservative treatment for two days does not give visible results, then this indicates the purulent nature of the inflammation and serves as an indication for surgical intervention.

Mastitis surgery

Operations for mastitis are carried out exclusively in a hospital, under general anesthesia(usually intravenous). At the same time, there are basic principles for the treatment of purulent lactational mastitis, such as:

when choosing an operative access (incision site), the need to preserve function and aesthetic appearance breast;
radical surgical treatment (thorough cleansing of the opened abscess, excision and removal of non-viable tissues);
postoperative drainage, including with the use of a drainage-washing system (long-term drip washing of the wound in postoperative period).

(Incisions during operations for purulent mastitis. 1. - radial incisions, 2. - incision in case of damage to the lower quadrants of the mammary gland, as well as in case of retromammary abscess, 3 - incision in case of subalveolar abscess)
Typically, incisions for purulent mastitis are made in the radial direction from the nipple through the area of fluctuation or greatest pain to the base of the gland.

With extensive destructive processes in the lower quadrants of the gland, as well as with a retromammary abscess, the incision is made under the breast.

For subalveolar abscesses located under the nipple, the incision is made parallel to the edge of the nipple.
Radical surgical treatment includes not only the removal of pus from the cavity of the focus, but also excision of the resulting abscess capsule and non-viable tissues. In the case of infiltrative-abscessed mastitis, the entire inflammatory infiltrate is removed within the boundaries of healthy tissues.

Phlegmonous and gangrenous forms of mastitis suggest the maximum volume of surgery, so that later plastic surgery of the affected breast may be necessary.

The establishment of the drainage-lavage system in the postoperative period is performed when more than one quadrant of the gland is affected and / or the patient's general condition is severe.

As a rule, drip washing of the wound in the postoperative period is carried out for 5-12 days, until the general condition of the patient improves and such components as pus, fibrin, and necrotic particles disappear from the washing water.

In the postoperative period, drug therapy is carried out, aimed at removing toxins from the body and correcting the general disorders in the body caused by the purulent process.

Antibiotics are prescribed without fail (most often intravenously or intramuscularly). In this case, as a rule, drugs from the group of I generation cephalosporins (cefazolin, cephalexin) are used, when staphylococcus is combined with E. coli - II generation (cefoxitin), and in the case of secondary infection - III-IV generations (ceftriaxone, cefpirome). In extremely severe cases, thienam is prescribed.

In destructive forms of mastitis, as a rule, doctors advise to stop lactation, since feeding a baby from the operated breast is impossible, and expressing in the presence of a wound is painful and not always effective.
Lactation is stopped with medication, that is, drugs are prescribed that stop the release of milk - bromocriptine, etc. Routine methods of stopping lactation (breast bandaging, etc.) are contraindicated.

Treatment of mastitis without surgery

Most often, patients apply for medical help with symptoms of lactostasis or in the initial stages of mastitis (serous or infiltrative mastitis).

In such cases, women are prescribed conservative therapy.

First of all, you should ensure the rest of the affected gland. For this, patients are advised to limit physical activity and wear a bra or bandage that would support, but not squeeze, the diseased chest.

Since the trigger mechanism for the occurrence of mastitis and the most important link further development pathology is lactostasis, a number of measures are carried out for effective emptying of the mammary gland.

A woman should express milk every 3 hours (8 times a day) - first from a healthy gland, then from a sick one.
To improve milk flow, 20 minutes before expressing from the diseased gland, 2.0 ml of the antispasmodic drotaverine (No-shpa) is injected intramuscularly (3 times a day for 3 days at regular intervals), 5 minutes before expression - 0.5 ml of oxytocin, which improves milk flow.
Since expressing milk is difficult due to pain in the affected gland, retromammary novocaine blockades are performed daily, while the anesthetic novocaine is administered in combination with broad-spectrum antibiotics in a half daily dose.

To fight infection, antibiotics are used, which, as a rule, are administered intramuscularly in medium therapeutic doses.

Since many of the unpleasant symptoms of the initial stages of mastitis are associated with the penetration of milk into the bloodstream, the so-called desensitizing therapy with antihistamines is performed. In this case, preference is given to drugs of the new generation (loratadine, cetirizine), since drugs of previous generations (suprastin, tavegil) can cause drowsiness in a child.

To increase the body's resistance, vitamin therapy is prescribed (vitamins of group B and vitamin C).
With positive dynamics, ultrasound and UHF therapy is prescribed in a day, which contributes to the early resorption of the inflammatory infiltrate and the restoration of the mammary gland.

Traditional methods of treating mastitis

It should be noted right away that mastitis is a surgical disease, therefore, at the first signs of an infectious-inflammatory process in the mammary gland, you should consult a doctor who will prescribe a full-fledged treatment.

In cases where conservative therapy is indicated, traditional medicine is often used in a complex of medical measures.

So, for example, in the initial stages of mastitis, especially in combination with cracked nipples, it is possible to include procedures for washing the affected breast with an infusion of a mixture of chamomile flowers and yarrow herb (in a ratio of 1: 4).
For this, 2 tablespoons of raw materials are poured into 0.5 liters of boiling water and insisted for 20 minutes. This infusion has a disinfectant, anti-inflammatory and mild analgesic effect.

It should be remembered that in the initial stages of mastitis, in no case should you use warming compresses, baths, etc. Warming up can provoke a suppurative process.

Prevention of mastitis

Prevention of mastitis consists, first of all, in the prevention of lactostasis, as the main mechanism of the onset and development of an infectious and inflammatory process in the mammary gland.

Such prevention includes the following measures:

Early attachment of the baby to the breast (in the first half hour after birth).
Development of a physiological rhythm (it is advisable to feed the baby at the same time).
If there is a tendency to milk stagnation, it is advisable to carry out a circular shower 20 minutes before feeding.
Compliance with the technology of correct expression of milk (the manual method is most effective, while it is necessary Special attention to give the outer quadrants of the gland, where milk stagnation is most often observed).

Since the infection often penetrates through microcracks in the nipple of the gland, the prevention of mastitis also includes the correct feeding technology to avoid damage to the nipples. Many experts believe that mastitis is more common in primiparous women precisely because of inexperience and violation of the rules for attaching a baby to the breast.

In addition, wearing a cotton bra helps prevent cracked nipples. In this case, it is necessary that the tissue in contact with the nipples is dry and clean.

The predisposing factors for the onset of mastitis include nervous and physical stress, so a nursing woman should monitor her psychological health, get enough sleep and eat well.
Prevention of mastitis not associated with breastfeeding consists in observing the rules of personal hygiene and timely adequate treatment of skin lesions of the breast.

Can I breastfeed with mastitis?

According to the latest WHO data, breastfeeding with mastitis is possible and recommended: " ... a large number of studies have shown that continuing breastfeeding is generally safe for the infant's health, even with Staph. aureus... Only if the mother is HIV positive is there a need to stop feeding the affected breast until she recovers."

There are the following indications for interrupting lactation:

severe destructive forms of the disease (phlegmonous or gangrenous mastitis, the presence of septic complications);
appointment antibacterial agents in the treatment of pathology (when taking which it is recommended to refrain from breastfeeding)
the presence of any reasons why a woman will not be able to return to breastfeeding in the future;
the patient's desire.

In such cases, special medications are prescribed in tablet form, which are used on the recommendation and under the supervision of a doctor. The use of "folk" remedies is contraindicated, since they can aggravate the course of the infectious and inflammatory process.

With serous and infiltrative forms of mastitis, doctors usually advise trying to maintain lactation. In such cases, the woman should express milk every three hours, first from the healthy breast and then from the diseased breast.

Milk expressed from a healthy breast is pasteurized, and then fed to the baby from a bottle; such milk cannot be stored for a long time either before or after pasteurization. Milk from a diseased breast, where there is a purulent-septic focus, is not recommended for the baby. The reason is that with this form of mastitis antibiotics are prescribed, when taking which breastfeeding is prohibited or not recommended (the risks are assessed by the attending physician), as well as the infection contained in such a mologue can cause severe digestive disorders in an infant and the need for treatment of the child.

Natural feeding can be restored after all symptoms of inflammation have completely disappeared. To make sure that it is safe to restore natural feeding for a child, a bacteriological analysis of milk is preliminarily carried out.

What antibiotics are most often used for mastitis?

Mastitis refers to a purulent infection, therefore antibiotics with bactericidal action are used to treat it. Unlike antibiotics with bacteriostatic action, such drugs act much faster, since they not only stop the multiplication of bacteria, but kill microorganisms.

Today it is customary to select antibiotics, focusing on the data on the sensitivity of microflora to them. Material for analysis is obtained by puncture of the abscess or during surgery.

However, at the initial stages, taking the material is difficult, in addition, such an analysis takes time. Therefore, antibiotics are often prescribed prior to such testing.

In this case, they are guided by the fact that mastitis in the majority of cases is caused by Staphylococcus aureus or the association of this microorganism with Escherichia coli.

These bacteria are sensitive to antibiotics from the penicillin and cephalosporin groups. Lactational mastitis is a typical hospital infection, therefore, it is most often caused by strains of staphylococci that are resistant to many antibiotics and secreting penicillinase.

To achieve the effect of antibiotic therapy, antibiotics that are resistant to penicillinase, such as oxacillin, dicloxacillin, etc., are prescribed for mastitis.

As for antibiotics from the group of cephalosporins, with mastitis, preference is given to drugs of the first and second generations (cefazolin, cephalexin, cefoxitin), which are most effective against Staphylococcus aureus, including against penicillin-resistant strains.

Do I need to do compresses for mastitis?

Compresses for mastitis are used only on early stages diseases in a complex of other therapeutic measures. Official medicine advises applying semi-alcoholic bandages to the affected chest at night.

Among folk methods you can use a cabbage leaf with honey, grated potatoes, baked onions, burdock leaves. Such compresses can be applied both at night and between feedings.

After removing the compress, the chest should be rinsed. warm water.

However, it should be noted that the opinion of the doctors themselves regarding compresses for mastitis was divided. Many surgeons point out that warming compresses should be avoided as they can aggravate the course of the disease.

Therefore, when the first symptoms of mastitis appear, you should consult a doctor to clarify the stage of the process and determine the tactics of treating the disease.

What ointments can be used for mastitis?

Today, in the early stages of mastitis, some doctors advise using Vishnevsky's ointment, which helps to relieve pain, improve milk flow and resolve the infiltrate.

Compresses with Vishnevsky ointment are used in many maternity hospitals. At the same time, a significant part of surgeons consider the therapeutic effect of ointments in mastitis to be extremely low and indicate the possibility of an adverse effect of the procedure: a more rapid development of the process due to the stimulation of bacterial reproduction by increased temperature.

Mastitis is a serious disease that can lead to serious consequences. It is untimely and inadequate treatment that leads to the fact that 6-23% of women with mastitis have relapses of the disease, 5% of patients develop severe septic complications, and 1% of women die.

Inadequate therapy (insufficiently effective relief of lactostasis, inappropriate prescription of antibiotics, etc.) in the early stages of the disease often contributes to the transition of serous inflammation to a purulent form, when the operation and associated unpleasant moments (scars on the mammary gland, disruption of the lactation process) are already inevitable ... Therefore, it is necessary to avoid self-medication and seek the help of a specialist.

Which doctor treats mastitis?

If you suspect acute lactational mastitis, you should seek help from a mammologist, gynecologist or pediatrician. In severe forms of purulent forms of mastitis, you should consult a surgeon.

Often, women confuse the infectious and inflammatory process in the mammary gland with lactostasis, which can also be accompanied by severe pain and an increase in body temperature.

Lactostasis and initial forms mastitis is treated on an outpatient basis, while purulent mastitis requires hospitalization and surgery.

In case of mastitis, which is not associated with childbirth and feeding of the child (non-lactational mastitis), they turn to a surgeon.

Acute inflammation of the mammary gland - mastitis usually develops in the postpartum period during lactation. In the initial (serous) phase of acute mastitis, treatment consists primarily in preventing milk stagnation, which should be expressed or, better, sucked off with a breast pump. The gland itself is suspended with a bandage. These events in initial stage may be enough to stop the inflammatory process. In doubtful cases, antibiotics are administered intramuscularly. Conservative treatment is also indicated in the infiltrative phase of acute mastitis. Intramuscularly prescribed methicillin 1 g 6 times a day, ampicillin 0.5 g 6 times a day, etc. Continue pumping milk to avoid stagnation in the gland.

During the abscessing phase, abscesses form in the mammary gland. If, within 3-5 days of outpatient treatment, it is not possible to stop the acute phase of mastitis, or if signs of suppuration of the infiltrate appeared even earlier, the patient should be immediately hospitalized in surgery department... The nature of the surgical treatment depends on the localization of the abscess: it can be located superficially, deep in the gland or under it. Accordingly, antemammary, intramammary and retromammary abscesses are distinguished.

The formation of an abscess in the mammary gland is an indication for an operation to open the abscess. Short-term intravenous anesthesia is usually used. Superficial limited abscesses can also be opened under local anesthesia. For this, retromammary novocaine blockade is performed. Additionally, the skin is anesthetized along the incision line. Usually, incisions are made radial with respect to the nipple, which do not reach it by 2-3 cm. The skin is dissected with a 5-7 cm long incision above the place of greatest pain and fluctuation. Deeper, the tissue of the gland is divided bluntly with the branches of a hemostatic clamp in order to reduce damage to the blood vessels and ducts of the gland. The abscess cavity is examined with a finger, the bridges are separated, if necessary, counterpertures are additionally performed at the base (lowest section) of the abscess cavity and drained with siliconized or rubber tubes. A large bandage is applied to the gland to absorb the purulent exudate.

Opening of retromammary abscesses is performed with a bordering incision along the fold under the gland. The cavity of the abscess is examined with a finger, washed with a solution of furacilin or hydrogen peroxide, and drained with tubes or rubber strips. Wound exudate flowing down the tubes is absorbed into the dressing. The nipple is left open for regular expression of milk. In order to accelerate the cleansing of the wound from necrotic tissues, the walls of the cavity are treated with a solution of proteolytic enzymes.

The most difficult are phlegmonous and gangrenous forms of acute mastitis, which often lead to sepsis, purulent-resorptive fever. Treatment consists of urgent opening of the phlegmon and drainage, intensive antibiotic therapy, blood transfusion and plasma substitutes. With a purulent-infiltrative form of mastitis, due to insufficient or incorrect treatment, a dense infiltrate with small abscesses develops in the mammary gland, the course becomes chronic. Surgical treatment consists in complete excision of the entire infiltrate with histological examination to exclude a possible cancerous degeneration.

In order to avoid infection of a child with purulent mastitis, it is recommended to express milk with a breast pump also from a healthy breast, boil it and only then feed the child. Slow resorption of dense infiltrate after acute purulent mastitis is an indication for physiotherapy (UHF therapy, paraffin applications). Prevention of mastitis consists in preparing the nipples for the upcoming feeding, and begins with the second period of pregnancy. The nipples are washed daily with warm water and soap and rubbed with a coarse towel, general courses are carried out ultraviolet irradiation... Incipient nipple cracks are well sanitized with 5% methylurapil ointment or oxycort. Important preventive measure is to maintain a strict sanitary and hygienic regime in maternity hospitals.