Postnatal breast issues

Breast Engorgement

The most common postnatal problem affecting breasts is marked breast engorgement, without infection. It may affect up to one in five new mothers. There is extreme discomfort and it may cause moderate fever. If there is no evidence of infection, all that is required is simple analgesics such as acetaminophen (paracetamol), adequate breast support, ice packs and - if the mother is not breastfeeding - fluid restriction.

Infectious mastitis

Infectious mastitis is less common. It is estimated that about 2.5% or one in forty new mothers will have infectious mastitis. This is a condition where there is general painful inflammation of a breast caused by a bacterial infection. A small minority of these will go on to develop a breast abscess.

Predisposing factors for infectious mastitis

Breast engorgement, nipple trauma and poor breast-feeding technique are some of the commonly cited factors increasing the risk of mastitis. The cause or risk factor is not always apparent.

Recognizing infectious mastitis

It is essential to distinguish infectious mastitis from simple breast engorgement since management is very different and time is of the essence to prevent possible escalation. Infectious mastitis commonly (but not always) affects one breast or the other and not both. Simple breast engorgement mastitis without infection tends to affect both breasts, though to varying degrees. Apart from the discomfort, even pain, there may be other less specific symptoms, including malaise and fever. Examination of the breasts will almost always reveal inflammation of the affected breast.

Treatment for infectious mastitis

Once recognized, broad-spectrum antibiotics should be commenced promptly. This should be complemented with painkillers such as Paracetamol or stronger ones, according to need, as well as adequate breast support.

Women who are breast-feeding do not need to stop. If continuing to breast-feed is impractical, then breast expression to prevent engorgement should be done. This could be done manually or by using a pump. The antibiotic course will be continued for a week or more.

Mastitis progressing into an abscess

This might happen. In such a case, incision and drainage of the abscess is required. Adequate drainage means the procedure normally requires a general anaesthetic.

Drainage will be combined with an antibiotic course. Breast-feeding is usually difficult to maintain on the affected breast before the abscess is drained. However, after this, there is no reason to prevent recommencing.

Lactation suppression options

For a mother who cannot or does not want to breast-feed, there are two broad alternatives for suppression of milk production (lactation). One is to use non-pharmacological means (i.e. no drugs). The other is to use drugs.

General measures where no drugs are involved include breast support, simple analgesics and meticulous fluid restriction. Milk expression should be avoided, as this encourages production of more milk and will prolong the period of suppression.
Drugs used for lactation suppression are taken daily for a period of two weeks. Lactation may start again after completing the course, which will necessitate recommencing the medication.

There is really no evidence that using drugs is more effective than using general measures.

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