Patient will infectious mastitis present as → a breastfeeding woman 3 weeks postpartum complaining of a painful area of the breast that is reddened and warm. The patient feels very fatigued with a fever of 101.5 ° F and chills. She reports a burning pain present constantly or at times only while breastfeeding. On exam, the patient appears ill. Breast examination shows an erythematous right breast with a palpable mass, induration, erythema, and tenderness to palpation.
Patient with congestive mastitis presents as → a primigravida with bilateral, painful breast engorgement.
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Mastitis is a condition in which bacteria enter the breast tissue through a milk duct or a fissure in the skin, caused by breastfeeding. Mastitis usually occurs within the first few weeks of breastfeeding but may occur later
- Mastitis occurs mainly in breastfeeding women. Rarely, this condition occurs in women who are not breastfeeding
- Infectious vs. congestive mastitis (unilateral vs. bilateral)
- Infectious (unilateral) - Unilateral, fever, chills, and color change
- Congestive (bilateral) - Bilateral breast engorgement that usually occurs in primigravidas
***Inflammatory breast cancer presents with breast tenderness and color change, but fever and chills are not usually present

Breast examination shows an erythematous right breast with a palpable mass, induration, erythema, and tenderness to palpation
Diagnosis is clinical – if an abscess is suspected and ultrasound may be warranted
- Culture of the breast milk can be useful to guide selection of antibiotics
- Blood cultures are warranted in the setting of severe infection
Treat with dicloxacillin 250 mg QID x 10 days for staphylococcus
- Patients should be encouraged to continue breastfeeding and apply warm/cold compresses to the infected area along with oral NSAIDs
Question 1 |
stop breast-feeding and have the mother express her breast milk until the infection is cleared | |
continue breast-feeding and treat the mother with hot compresses and antibiotics | |
continue breast-feeding and treat both the mother and the infant with antibiotics | |
discontinue breast-feeding for now and provide antibiotics to the mother | |
discontinue any further breast-feeding and perform an incision and drainage immediately |
Question 2 |
Check latch-on and determine if the baby is positioned properly | |
Encourage the use of different breastfeeding positions to massage different milk ducts | |
Make sure the patient is getting adequate rest and hydration and is not waiting too long between feeds (or pumping) | |
Check nipples for cracks, fissures, or signs of fungal infection | |
All of the above |
List |
References: Merck Manual · UpToDate