Inflammation of the breast outside the confinement period

Inflammation of the breast outside the confinement period

Inflammation of the breast outside the confinement period (Non-puerperal mastitis, MNP): Acute inflammation of the mammary glands, usually the result of other breast diseases such as mastopathy or macromastia, also occurring after taking certain medications (psychotropics or estrogen preparations) that stimulate milk secretion. About 90% of cases occur in women of sexual maturity, only 10% of cases affect women after menopause. In recent years, the incidence of MNP has increased sharply, meanwhile the proportion of all mastitis is about 50% (compared to 5-10% before). The reasons for this are not yet known.

This form of mastitis is rarer than puerperal mastitis.

mammary gland abscess: Encapsulated collection of pus in a breast cavity that has developed due to the melting down of inflamed breast tissue. An abscess occurs in almost 40% of all breast infections outside of breastfeeding and usually has to be treated surgically.

leading complaints

• The breast is usually painfully reddened and overheated on one side, the nipple is particularly painful
• fever
• Pronounced feeling of illness with headache and body aches
• Enlarged lymph nodes in the armpit
• lactation
• With abscess formation: swelling of the affected tissue.

Inflammation of the breast in a 35-year-old woman who had been taking psychotropic drugs for six months. The right breast is painfully red and overheated. Here the gynecologist had to wait for the abscess to mature and then open the abscess so that the pus could drain out.
Georg Thieme Verlag, Stuttgart

When to the doctor

The next day if

• the breast begins to redden and become overheated.
• cooling compresses bring no improvement.

Immediately if

• the breast is painfully red, swollen and warm.
• high fever and chills occur.

The illness

causes

Even outside of breastfeeding, hormonal imbalances and stress lead to milk being produced and secreted to the outside (galactorrhea). Accordingly, a blocked duct is often a breeding ground for the multiplication of germs and for the development of breast inflammation. The secretion from the nipple is not so much the cause but rather an expression of the disease.

A breast infection is also triggered when the nipple is pulled inward and a dimple is formed (inverted nipple or inverted nipple). Secretion collects in this dimple. Along with the germs present on the skin, an infection of the mammary gland develops.

In the context of the so-called galactography, an infection sometimes occurs. In this examination, a contrast medium is injected into the milk ducts in order to then take a mammogram of the breast. If there are tears in the milk ducts, the contrast medium may penetrate the breast – for example if there is a lack of hygiene. This is how pus pathogens get into the milk ducts, which leads to breast inflammation.

The breast often becomes inflamed in the case of an immune deficiency, diabetes mellitus or rheumatoid arthritis.

There is also a risk of inflammation with nipple piercing. Poor hygiene, friction caused by clothing that is too tight or changing the ring before it has completely healed allows germs to get into the wound. These get into the milk ducts, causing breast inflammation.

Other risk factors are:

• Drugs such as psychotropic drugs or the “pill”
• smoking
• Previous injury to the mammary gland
• mastopathy.

course

The chances of healing breast inflammation outside the confinement are slightly lower than in the case of breast inflammation in the confinement, there is a risk of a chronic course. In almost 30% of all cases, the inflammation reappears after treatment.

trigger

Bacterial MNP is caused by the following pathogens: Staphylococcus epidermis (40%), Staphylococcus aureus (40%), streptococci, E. coli, Pseudomonas and Proteus.

diagnostic backup

palpation. The diagnosis can be made on the basis of the symptoms and careful palpation of the overheated and very painful chest.

Ultrasonic. The doctor uses an ultrasound to rule out abscess formation.

mammography. Since the symptoms of breast inflammation are similar to those of breast cancer, the presence of a tumor must be ruled out. Mammography provides a reliable diagnosis.

Biopsy. If mammography is not sufficient to confirm the diagnosis, a biopsy is performed. This also clarifies whether the breast infection is a symptom of another underlying disease such as tuberculosis, syphilis or fungal infections.

treatment

pharmacotherapy

Since milk secretion from the breast also occurs with breast inflammation outside of childbirth, treatment is given early with prolactin inhibitors that block milk secretion (e.g. Bromocriptin-ct®). It is important that the treatment lasts long enough, otherwise the symptoms will return quickly or the inflamed tissue will melt into an abscess.

If bacteria are proven to be the cause of the breast infection, antibiotic treatment is given, for example with flucloxacillin, cephalosporin or oxacillin. If it is an abacterial breast infection, the therapy consists of prolactin inhibitors.

abscess treatment

If an abscess already exists, it is brought to maturity with heat applications (red light or short wave). The doctor then cuts into the abscess under short-term anesthesia and drains the purulent liquid through a drain. In addition, it is treated with antibiotics. This procedure can be performed on an outpatient basis.

forecast

The prognosis is good if the causes of the mastitis can be found and treated, otherwise recurrences are common.

Your pharmacy recommends

What you can do yourself

• Take the pressure off your breasts by not wearing a bra that is too tight, for example.
• Place cooling curd wraps on chest three to four times a day. To do this, take a clean cotton cloth or a compress and spread half a centimeter of cool quark on it. Then place the wrap on the painful area on the chest so that there is a layer of fabric between the skin and the curd.
• Gently massage your chest.
• In the case of bacterial inflammation (abscess), heat in the form of red light or warm compresses often help.

complementary medicine

In addition to individually tailored acute remedies, homeopathy recommends arnica and complex remedies (e.g. Naranotox plus®), which are said to have an anti-inflammatory effect. If the symptoms do not improve within twelve hours, a doctor should be consulted.

authors

dr medical Astrid Waskowiak, Dr. medical Arne Schäffler in: Health Today, edited by Dr. medical Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). | last changed on 07/14/2020 at 1:19 p.m

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