Tangshan People's Hospital Breast Surgery Department
Acute mastitis is an acute suppurative infection of the breast, most of which occurs in postpartum lactating women, especially primipara. The onset is usually 3 to 4 weeks postpartum.
Visiting department
Surgery
Multiple population
Most primipara
Common location
breast
Common causes
Milk stasis, bacterial invasion
common symptom
Breast swelling and pain;Painful lumps appear in the affected area, and the skin is red and hot on the surface
The causes of acute mastitis, in addition to postpartum systemic resistance decline, there are the following two incentives.
1. Milk stasis
This is an important cause of disease.The reasons for milk stasis are: nipple dysplasia (too small or invaginated) hinders lactation;Too much milk or too little sucking of infants, resulting in incomplete emptying of milk;The milk pipe is blocked, affecting milk discharge.
2. Bacterial invasion
The main route of infection is nipple rupture and skin erosion around the areola.Infant oral infection, sucking milk or sleeping with nipples, causing bacteria to enter the milk tube directly is also one of the ways of infection.
clinical manifestation
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Breast swelling and pain in the initial stage;There are tenderness lumps in the affected area, and the skin is red and hot on the surface;At the same time, fever and other systemic symptoms may occur.If the inflammation continues to develop, the above symptoms will become worse. At this time, the pain is pulsating, and the patient may have chills, high fever, and fast pulse.The axillary lymph nodes on the affected side are often swollen and tender.The white blood cell count was significantly increased and the nucleus shifted to the left.Inflammatory masses often soften and form abscesses within a few days. Superficial abscesses can be touched and fluctuated. Deep abscesses can only be determined by puncture.Breast abscesses can be unilocular or multilocular due to delayed drainage;Or from the outside through the skin, or the abscess broke into the breast tube to form nipple discharge;The same breast can also have several lesions at the same time to form multiple abscesses.In addition to slowly collapsing outwards, deep abscesses can also penetrate deep into loose tissue between breast and pectoral muscle to form retromammary abscesses.Severe acute mastitis can lead to massive necrosis of breast tissue and even sepsis.
inspect
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The white blood cell count of blood routine examination is generally increased.There was no obvious change in the early stage of B ultrasound, and pus cavity could be formed in the late stage.
diagnosis
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The diagnosis can be made according to the above symptoms, signs and laboratory tests.
treatment
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1. Abscess free stage
(1) General treatmentStop breastfeeding on the affected breast to avoid affecting the baby's health, and take measures to promote smooth milk drainage (such as sucking out milk with a breast aspirator) to remove the factors of milk stasis.
(2) Local physiotherapy and hot compressIt is beneficial to the early dissipation of inflammation;Those with obvious edema can use 25% magnesium sulfate wet hot compress.
(3) Partial closureIt can promote early inflammation to dissipate.
(4) Systemic anti infectionApplication of antibiotics (cephalosporins, ofloxacin, metronidazole).
2. Abscess formation stage
The key point of treatment is to cut and drain the pus in time.The key is to prevent and cure milk stasis, avoid nipple damage, and maintain local cleanness.In the later period of pregnancy (especially the primipara), the nipples on both sides should be washed with warm soapy water frequently;If the nipple is invaginated, it can be corrected by frequent squeezing and pulling (surgery is required for individual correction).To develop regular breastfeeding, infants without nipples and sleep and other good breastfeeding habits.Suck up the milk every time you breastfeed. If there is any accumulation, you can use a breast aspirator or massage to help empty the milk.The nipples should be washed after breastfeeding.If the nipple is damaged or broken, it should be treated in time.Pay attention to the oral hygiene of infants and treat their oral inflammation in time.
