ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. N61N60O91ArtikelübersichtMastitis
- Causes and risk factors
- Examinations and diagnosis
- Disease course and prognosis
Mastitis is a mastitis. It is caused mainly by bacteria. However, other factors such as lactation during lactation, stress or hormonal fluctuations can also cause a breast infection. Mastitis is almost always one-sided.
Physicians distinguish between puerperal mastitis and non-puerperal mastitis. Mastitis puerperalis is a breast infection that occurs during the puerperal and breastfeeding. It affects about one percent of all women who have recently given birth. Inflammation of the breast (= breast) while breast-feeding is called non-puerperal mastitis.
Occurrence of mastitis
Mastitis is a typical disease of the reproductive woman. Therefore, most often 20- to 40-year-olds get a breast infection. Only ten percent of all cases of non-puerperal mastitis are found after menopause.
Men rarely develop mastitis. The disease can also occur in newborns. In this case, doctors speak of a mastitis neonatorum. It usually develops between the fourth and sixth day after birth.To the table of contents
There are a number of typical mastitis symptoms. The signs of mastitis puerperalis differ only marginally from mastitis non-puerperalis. Mostly the breast is swollen and hardened in the inflamed area. In this area also often occurs a significant redness. The inflamed chest feels considerably warmer than the non-affected. Typically, patients experience pain as they scan the inflamed site. A pain in the area of the nipple is considered a possible mastitis symptom.
About half of those affected swell the lymph nodes below the armpit. As a rule, this enlargement is painful. In the case of a breast infection in the puerperium, the patients often additionally suffer from general physical complaints. These include chills, malaise and fever with temperatures above 38.4 degrees Celsius. Those affected feel tired, severely beaten and very ill. The secreted milk is changed. It tastes salty, so many infants refuse to drink at the breast.
Usually, the upper area on the outside of the breast is inflamed. If a mastitis is not treated in time, the inflammation can spread to the entire breast. In some cases, the inflammation capsules. It accumulates a large amount of pus (abscess). Experts call this process abscessing. The abscesses can feel a knot on the patient who gives in under pressure and is very painful. Under certain circumstances, passages form from the abscess to the nipple or to the skin surface. Doctors refer to these tubular connections to the body surface as fistulas.
Breast inflammation in newborns is also associated with typical mastitis symptoms. As with adults, usually only one breast is affected and inflammatory red and hot. Diseased babies often cry because of the pain, especially if the inflamed chest is touched. The mastitis neonatorum is usually preceded by a swelling of the breast. In many cases, milk also comes out of the affected breast, which is also called witch's milk. Do not try to pressure-drain a child's breast swelling, as it increases the risk of infection.To the table of contents
Mastitis: causes and risk factors
Bacterial mastitis puerperalis
By far the most common causative agent of puerperal mastitis is the bacterium Staphylococcus aureus. With just under 95 percent, he is significantly more often detected in this breast infection than in non-puerperal mastitis. Less common are other germs such as streptococci, Proteus bacteria, pneumococci or Klebsiella. The pathogens enter the baby's nose and mouth from the mother or other persons in the immediate vicinity (relatives, caregivers). During breastfeeding, the germs are then transferred to the maternal breast.
Breastfeeding causes small skin tears (rhagades) around the nipple. They are the gate through which the bacteria usually first penetrate the lymphatic channels of the mammary gland. In this case, doctors speak of interstitial mastitis, which means "lying in the interstices of the glandular tissue". Under certain circumstances, the bacteria also get directly into the milk ducts. This so-called parenchymatous mastitis is mainly favored by a congestion. The milk ducts are then significantly widened by the accumulated secretions and thus more accessible to germs.
Non-bacterial non-puerperal mastitis
In most cases of non-bacterial (abacterial) breast inflammation, a congestion is the direct cause of mastitis. In doing so, the mammary gland produces too much milk that can not drain off quickly enough - for example, because the breast tissue has changed to scar tissue as a result of previous inflammations or injuries. Through the accumulated secretions, the milk ducts (ductus lactiferi) widen and the milk penetrates into the surrounding tissue between the mammary lobes. There, the secretion is fought like an intruder - the chest is inflamed. In the further course germs can settle and multiply in the inflamed breast area. Thus, from an abacterial bacterial mastitis.
High blood levels of the messenger substance prolactin cause an increased milk production. This hormone is responsible for breast growth and milk production. It is produced in the pituitary gland and is normally released during pregnancy and lactation. Outside of this time, stress, thyroid disorders, medications (e.g., metoclopramide) or pituitary tumors can lead to increased release of prolactin. In some cases, the cells of the mammary gland are very sensitive to the hormone. Then even small amounts of prolactin cause the mammary gland to secrete more milk.
Bacterial mastitis non-puerperalis
With a good 40 percent of the germ Staphylococcus aureus is the most common cause of bacterial breast infection outside of breast-feeding. The globular bacterium Staphylococcus epidermidis causes an inflammatory reaction in the mammary gland just as often. The bacteria Escherichia coli, Proteus, Fusobacteria and streptococci are also the cause of non-puerperal mastitis. Much less often does it come in the context of another infectious disease - such as tuberculosis, lues, leprosy, radiation fungus disease or typhoid fever - to a breast infection.
About injuries to the breast and the nipple or small skin tears, the germs get into the breast tissue. There they can settle and multiply. The body's defense is against the invaders and the chest is inflamed. Spreading of the bacteria via the bloodstream is very rare. Only with additional purulent diseases such as a furunculosis, the risk of germ colonization is increased. Boils are painful, purulent inflammation of the hair root and occur frequently in the chest, neck and groin.
Other mastitis risk factors
There are many factors that may favor non-puerperal mastitis. Women who have already breastfed a child, or who injure themselves on the breast or nipple, are more likely to develop breast infection. But medications can also cause mastitis. Contraceptive pills containing a high proportion of the female sex hormone estrogen (estrogen-based contraceptive contraceptives), tranquilizers or menopausal (e.g., gynodian) drugs make women more susceptible to mastitis. In addition, there are some breast diseases in which mastitis non-puerperalis occurs more frequently.
An example of this is the so-called fibrocystic mastopathy. Large cavities filled with liquid form in the breast tissue. These cysts are more easily colonized by bacteria. Patients often suffer from cycle-dependent pain in the breasts, say doctors of mastodyne. Particularly large breasts refer doctors as macromastia. Both favor a breast infection.
Even if the nipples turn inside out, the chest becomes more inflamed. Physicians refer to this phenomenon as slippery or hollow warts. Studies have also found that non-puerperal mastitis recurs more frequently, especially in heavy smokers.
In the body of some newborns still affect the hormones of the mother - including the milk production stimulating prolactin. In that case, the infant's breasts may swell and secrete a milky fluid. This secretion is also called witch's milk. If the witch's milk builds up, the child's breast can catch fire, especially when trying to force the milk out. Hormones of the mother cake (placenta) or a direct infection with bacteria can cause mastitis.To the table of contents
Mastitis: diagnosis and examination
A gynecologist can usually detect mastitis quickly. First, he asks about the complaints:
- What has changed on your breast?
- Does your chest hurt?
- Do you feel sick and severed?
- Do you have chills or fever?
- Which medications do you take?
- Have you recently given birth?
- Did you already have a breast infection?
- Do you currently breastfeed?
Complaints during breastfeeding indicate puerperal mastitis. The typical symptoms of redness, overheating and swelling of the breast are easy to detect in the subsequent physical examination. In addition, the doctor will scan the breast and the surrounding lymph nodes. If a swelling in the chest is easy to press in, this indicates an abscess.