What Are the Common Causes of Pus in the Breast?

Mastitis is a common disease in women. It can be divided into acute purulent mastitis, para-areolar fistula, plasma cell mastitis, etc. according to the different causes. The most common acute purulent mastitis is described here. Acute purulent mastitis often occurs during lactation, especially within 1 to 2 months after delivery. It is also called acute lactation or puerperal purulent mastitis, and is called "milk palate" by Chinese medicine. The incidence of acute mastitis in primiparas is as high as 2% to 4%, which is twice as high as in postpartum mastitis. The milk stasis is accompanied by bacterial infection and develops with acute inflammation, redness, swelling and pain, chills and high fever. In the early stage, breast milk can be drained by hand, treated with traditional Chinese medicine, and incision and drainage are needed after purulence. After the onset of the disease, not only the maternal pain is abnormal, but also can not continue breastfeeding, affecting the health of the baby, so prevention should be started from the late pregnancy, and the puerperium health care can be done. Acute mastitis can be prevented.

Basic Information

TCM disease name

Milk

English name

mastitis

Visiting department

Breast surgery

Multiple groups

Primipara

Common causes

Lactostasis and Staphylococcus aureus infection

Common symptoms

High fever, chills, breast pain, swelling, ulcers, tenderness, etc.

Causes of mastitis

Milky stasis is a prelude and basis for bacterial infections. Too much milk, poor milk production, milk can become lumpy. Stuck milk is the best medium for bacteria. Most of the milk stasis is caused by lack of breastfeeding experience or improper methods. The pathogenic bacteria are mostly Staphylococcus aureus, and a few are hemolytic streptococci. The nipple skin is damaged or the milk duct penetrates the parenchyma of the mammary gland. A large number of them multiply and destroy the mammary gland tissue. Atrial abscess. When the nipple is underdeveloped, the nipple is sunken, or the nipple is inverted or split, the mammary ducts do not drain milk smoothly and cause siltation. Breastfeeding is too long, children "sleep with milk", causing the nipple surface to erode or children to bite the nipple, bacteria enter through the mouth; or due to colds, pharyngitis, bacterial blood flow into the stagnant milk and multiply and purify.

Postpartum constitution is weak, immunity is reduced, packages are too tight, sweating is more, cleaning is not enough, breasts are locally moist, and it also provides a breeding ground for bacterial growth and reproduction. Traumas such as squeezing and impacting breasts during lactation can easily induce mastitis.

Clinical manifestations of mastitis

The clinical manifestations of acute mastitis can be divided into three or three stages.

In the first stage, stasis or swelling or swelling. The main manifestation is a certain part of the breast, usually in the upper and outer quadrants, with sudden swelling and pain, unclear borders, and more obvious tenderness. The inflammation inside the breast at this stage was a cellulitis stage and no abscess had formed. The color of the breast skin is normal or reddish, or slightly hot. Suddenly high fever, chills, pain, swelling, local redness, and suppurative ulceration soon, mostly accompanied by chest tightness, headache, loss of appetite and so on. If there is a cracked nipple, the breast will feel as painful as a needle stick during breastfeeding. One or two small pus spots or small cracks can be seen on the nipple surface.

Second stage, the formation of abscess. Cellulitis did not dissipate in time, inflammation continued to develop, tissue necrosis, and abscess formation were inevitable. The lump gradually became larger and harder, and the pain worsened, mostly pulsating tenderness, and even persistent severe pain. The breast skin became red and hot. The body is full of heat, thirst, drink, nausea, anorexia, and ipsilateral axillary lymph nodes. After 2 to 3 days of swelling and hot pain, the center of the mass became soft and fluctuating, the center became red and swollen and shiny, the skin became thin, and large areas of peripheral skin were bright red. The pus will be sucked out during the puncture. This stage of the abscess has come, and the time for conservative cure has passed.

Stage III, late stage of abscess ulceration. When the abscess matures, it can be ulcerated by itself, or the pus can be removed by surgery. If the drainage is smooth, the local swelling and pain will be reduced, and the temperature will be normal. After the dressing change, the wound will gradually heal within about one month. If the pus does not flow smoothly after swelling, the swelling does not go away, the pain does not diminish, and the body heat does not return, it is the poor drainage, which will turn into chronic mastitis over time, and a breast fistula will also form, that is, milk with pus mixed out .

Mastitis examination

Acute mastitis can be diagnosed by clinical observation and touch. The most commonly used test is blood, elevated white blood cells or neutrophils. Color Doppler ultrasound can determine the location and size of the pus cavity. Take a small amount of pus during puncture or incision for bacterial culture plus drug sensitivity test to provide guidance for the application of antibiotics.

Mastitis diagnosis

The diagnosis of acute purulent mastitis is relatively easy. The diagnosis can be made based on breast swelling and pain, body temperature as high as 39 ° C to 40 ° C, and increased blood white blood cell count. If the abscess is deep, the pus cavity is located in the posterior gland space, and the skin is often not obvious. At this time, the puncture is required to extract the pus to confirm. If it is not treated properly, the abscess formation is slow, the local mass does not disappear, the skin is swollen and the systemic symptoms are not obvious, and the chronic inflammation is formed, it needs to be distinguished from other diseases.

Mastitis treatment

Acute mastitis should be treated as early as possible. Early mastitis is dominated by stasis inflammation, which has not yet become pus. Ultrashort wave physiotherapy can be used. If high fever can be combined with infusion, penicillin, cephalosporin antibiotics. It is recommended not to breastfeed during antibiotic use.

When acute mastitis reaches the stage of abscess formation, it needs to be opened and drained in time. The size and position of the incision are based on the principle of ensuring the smooth flow of pus. Because breast abscesses are often multifamily, the connective tissue space between multiple abscess cavities needs to be separated by fingers for drainage to be unobstructed. Abscesses in deep breasts are mainly fever, chills, local redness and swelling are not obvious, and there is no sense of fluctuation. A puncture and pus test can be performed to confirm the abscess and then cut. Breast abscesses are best not to wait for spontaneous ulceration, because the abscess cavity is often multiple or one after another, and the spontaneous ulcer cannot be completely drained. Generally, suppurative mastitis as long as the pus is clear and the fever retreats, it will then enter the wound healing period. The dressing will be changed every other day, and the wound will heal within one month.

Mastitis prevention

Acute suppurative mastitis is preventable and should be prevented. This is an integral part of women's health care during the puerperium. It is not difficult to understand the cause of acute mastitis. The key is two: to prevent milk stasis, to keep the breasts clean and the physical and mental health of the mother. In the last two months of pregnancy, be prepared to breastfeed. First of all, to keep the breasts clean on both sides, often wash the nipples with water or 3% boric acid water. Be careful not to use soap-based cleaning products to clean the breast, because during pregnancy, the secretions of the sebaceous glands and sweat glands on the breasts will increase. These substances can protect the skin by acidifying the surface. If the protective layer is often washed away with soap or the like, and even the grease that protects the lubricity of the breast skin is washed away, it is easy to cause the breast surface to become damaged and cracked, and the germs are likely to invade and cause infection.

Strive to start breastfeeding within 30 minutes after giving birth, commonly known as opening milk. Early baby sucking will stimulate lactation, which will not only increase the amount of lactation, but also promote the smooth flow of milk and prevent stasis. This is very important for preventing mastitis.

If there is a congenital malformation of the nipple, such as a sunken nipple, a split, etc., it is necessary to find a way to correct it in the first and second trimester of pregnancy. Often pull the nipple by hand, or suck it out with a breast pump or a negative pressure cupping cup, 1 to 2 times a day. It is best to lie on your back in the sleeping position to avoid squeezing your breasts sideways. It is advisable to choose a suitable bra so as not to make the breasts feel oppressive, and to avoid external forces from hitting the breasts during normal activities.

During lactation, it is important to prevent the following four aspects to prevent and treat acute mastitis.

The first is to vary from person to person and supplement as needed. Some mothers did not go well when milking, and the family rushed to stew fish soup and trotter soup to supplement the body. In fact, this approach is not necessarily appropriate. First of all, what is the reason for the lack of milk? Is it due to low milk secretion or milk stasis due to blocked milk ducts? That is, it is distinguished whether there is less real milk or less pseudo milk. Because in many cases, milk is continuously secreted, and it accumulates in the breast, but because the mammary ducts are not yet smooth and cannot be discharged smoothly, the performance is "not much milk", which means that there is less fake milk. At this time Supplementing the milk's food can only have an adverse effect, which can easily lead to the occurrence of acute mastitis.

The second is to keep the breasts clean. During lactation, you can use gauze dipped in warm water to wash and then breastfeed. After breastfeeding, wipe the breasts and nipples with warm water. Do not use chemicals such as soap and alcohol to scrub the nipple, otherwise the local defense ability of the nipple will be reduced, and the nipple will dry and cause bacterial infection.

The third is to breastfeed correctly. Promote regular breastfeeding, preferably every 2 to 3 hours. The two breasts are fed alternately, preferably with equal opportunity, to prevent asymmetry of the breasts on both sides after breastfeeding. Drain your breasts and don't collect milk. When one breast can feed the baby, the breast on the other side should be evacuated with a breast pump. Don't be sorry, because the milk is "eat more and more." Of course, it can also be stored in the refrigerator when there is insufficient milk. Do not let the baby's mouth with nipples sleep after feeding. The baby's saliva contains digestive enzymes, which can cause milk to form a cheese-like substance, blocking the mouth of the milk duct, causing poor milk discharge and even siltation. The breastfeeding position should be correct, it is best to use a sitting position and less to a lying position. After feeding, the baby should be held upright, with his head resting on his mother's shoulders, and patted his back gently. This will allow the baby to take out the air inhaled during feeding to prevent spitting. Wearing a suitable bra after breastfeeding can support the breast, keep the blood circulation inside the breast unblocked, and help correct breast sagging.

The fourth is a milk massage. A cesarean woman often delivers milk slowly, and her milk is insufficient at the beginning, so she needs to have a milk massage in time. The manual milking time should be 20-30 minutes each time, and the single time should not be too long. If milking is not successful at one time, simply increasing the massage time can only increase the probability of local edema. The correct method of massage is to first apply paraffin oil or Kaisailu to lubricate the skin, slide your fingers from the outer edge of the breast to the areola, and then pull the nipple up and down several times, causing local negative pressure under the areola, so that it is similar to a baby sucking effect. In addition to the stimulation of the massage technique, after the massage, the child can be sucked and the breast milk reflex can be increased. In this way, the dual effect of massage and sucking will be better, and the occurrence of acute mastitis can be reduced.

The fifth is to keep the environment clean and emotionally stable, and avoid anger. The temperature and humidity of the parturient's room should be appropriate, generally 22 24 , and the indoor air should be fresh. Some people think that the mother is afraid of the wind, sweats easily, and catches a cold. Therefore, the doors and windows are closed tightly, and the indoor air is dirty, which is harmful to both the mother and the baby. In addition, proper diet, smooth stool, and emotional stability are important to the mother. Chinese medicine believes that acute mastitis is caused by liver stagnation, qi stagnation and stomach fire. The liver qi is stagnation, and the ducts are blocked. Horrified and furious, lactation ceased. Therefore, I feel comfortable and emotionally stable. I usually pay attention to preventing trauma to the breast from being squeezed and bumping. These are very important to prevent mastitis.

Bruised lumps can be applied cold in ice packs, not hot, and should not be rubbed casually.