PANCE Blueprint Reproductive System (7%)

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