Introduction
Mastitis is the inflammation of the mammary gland, “The breast as defined by Denise (2004) chronic mastitis is a name formerly applied to the nodular changes in breast now usually called fibrocystic disease.
According to Klein (2003) “Mastitis is a breast infection of the perperium or post – partum period largely related to incomplete or partial emptying of the breast and posting of milk in the ducts of the breast feeding mother”.
Mastitis could be infected or non – infected. Infected mastitis is due to the presence of bacteria, which entered the breast through the cracked nipple or through the ducts. It resolves when antibiotics are administered. Non – infected mastitis is due to statis and engorgement of the breast is completely emptied.
Mastitis usually begins more than two or four weeks after delivery of the baby. It is relatively uncommon complication of breast feeding mothers, occurring in only approximately 3% to 5% of nursing mother.
Some of the causative agents, the most common bacteria causing mastitis is staphylococcus aureus and staphylococcus albicans.
Mastitis affects women with poor personal hygiene, cracked nipple, poor positioning of either the suckling baby’s mouth to the areola of the mother or excessive sucking.
According to Alan(2004) “ Congestive mastitis or breast engorgement is more common in primigravida than in maltiparas”. Infectious mastitis and breast abscesses are also more common in women pregnant for the first time and are seen almost exclusively in nursing mothers. “They are stated under etiology that infectious mastitis and breast abscesses are uncommon complication of breast feeding. They almost certainly occur as a result of trauma to the nipple and the subsequent introduction of micro – organism from either the infant skin or nostril to the mother’s breast. They identified Staphylococcus aureus contacted by the infant while in the nursery (hospital) as the casual agent mastitis occurs on the second or third day post partum. The breast appears swollen, tender, and tense and warm, slight increment in the temperature with auxiliary adenopathy.
Mastitis presents one week or more after delivery usually, only one breast is affected and often only one quadrant or lobule. This is the acute form of mastitis. The acute form may progress to infective mastitis making the affected breast to be purulent. The patient is febrile and appear ill.
Other causative organics of infective mastitis and breast abscess are streptococcus species and E.Coli, leucocytosis is evident. Die – Dona (2001) defined mastitis as the inflammation of the breast occurring mainly in the peuperium period usually the first five days. They identified two types of mastitis. The acute non – infected mastitis and acute infected mastitis. The acute non – infected results from cracks on the nipples while the infected results from the passage of micro – organism through the cracks on the nipple into the breast tissues. The infectious mastitis is caused by Staphylococus aureus and streptococcus species.
Conceptual framework
According to David (2007) also defined mastitis as the inflammation of the breast in the first seven days of peurperial period affecting one breast. He further explained that breast abscess usually results from infection. When pathogenic micro – organism gained entrance into the breast through a sore or cracked on the nipple. He suggested that the affected breast if not infected should be given to the child to decongest the breast in conjunction with the administration of appropriate antibiotics to the mother.
Dianne (2009) mastitis is the inflammation of the breast occurring in the first week pest partum affecting one breast and further explained that it could be acute or chronic. The casual organism are staphylococcus aureaus and streptococcus. The acute form is the non – infected mastitis presenting with engorgement, tensed, tenderness and a very painful breast. This type is resolved by prompt empting of the breast either through the suckling baby or effective manual expression if the baby is not alive.
The chronic mastitis tend to become infected which usually result to breast abscess formation. It can be resolved by the administration of antibiotics and incision and drainage. The child is not allowed to suck from the suppurated breast. Laboratory investigation is done with sample of the breast milk to isolate the organism and also culture and sensitivity test done for adequate treatment.
According to Davis (2008) mastitis is inflammation of the mammary gland or the tissues about it. These inflammations be in the skin round the nipple or little abscess may from in one of the tubercles of Montgomery. The inflammation may be in one or more lobes of the gland-the-so-call parenchymatous form, or glandular mastitis. If the inflammation process occurs in the flat and loose tissue between the lobes, we speak of periglandular mastitis, and if the infection travels beneath the gland to the connective tissue, which fastens the breast to the chest walls, we feel pus under the gland and speak of submamary abscess. This is very serious and fortunately. Rare. The commonest is the parenchymatous variety and it is the most amenable to treatment.
The cause of all mastitis is infection by varieties of organisms of which staphylococcus aureus is the most common offender although several streptococci, colon bacilli and the pneumococcus are also encountered. Bacteria obtain access to the gland and set up inflammation. Normally, many breast contain germs (normal floral) but these are either naturally harmless or require special conditions to make them virulent. Such conditions are cracks, ulcer of the nipple, bruising of the breast, either by too brisk message or injury too much pumping of the breast, squeezing of the breast and effort to induce them to secrete milk when they cannot. Milk stasis and engorgement do not cause infection but over stimulation of the breast may result in infection and abscess.
The germs are often carried directly to the breast on the fingers of patient or nurse from the lochia, soil gown pulled over the nipple, from an infected umbilicus or by the baby during nursing. As a rule these can be prevented by proper protection of the breast and continual watchfulness in avoiding contamination. Asepsis should be mainained when handling the cracks and tissues on the nipples.
Anatomy and physiology of the breast
Syliva (2007) described the female breast, are also known as the mammary glands and are accessory organs of reproduction. They are two in the syanumber situated on each side of the stenum and extends from the level of the second to the sixth rib. The breast lie on the superficial facial of the chest wall over the pectoralis major muscles and are stabilized by suspensory ligaments.
Each breast is hemispherical swelling in shape and has tail of tissues towards the axilla. The size varies from individual to individual and with the state of development as well as with age
Gross structure: The axillary tail is the tail of tissues extending towards the axilla. The areola is a circular area of pigmented skin, about 2.5cm in diameter at the centre of the breast. It has a pale pink colour in fair skinned women, darker in a brunette, the colour depending with pregnancy. Within the area of the areaola lie approximately twenty sebaceous glands. This nipple lies in the center of the areola, at the level of the fourth rib. A protuberance about 6mm (0.2) in length, comprising of pigmented erectile tissues which are highly sensitive. The surface of the nipple is perforated by small opening of the lactiferous duct.
Microscopically, the breast is composed largely of the glandular tissues but also of some fatty tissues, and is covered with skin, the glandular tissue is divide into lobes which are completely separated by bands of fibrous tissues. The internal structure is said to resemble the segments of a halved grape or orange. Each lobe is a self contain working unit and is composed of:
- Aveoli which are also the acini’s cell. They secretes breast milk
- Lactiferous duct – this is a central duct in which the tubules run.
- Lactiferous tubules – they are small ducts, which connects the alveoli
- Ampulla – this is the widened – out portion of the duct where breast milk is stored temporarily.
- Continuation of the lactiferous ducts – these continue from the ampullar through the nipple to form pores on the nipples.
Blood supply: The internal mammary artery, the external mammary artery and the upper intercostals arteries supplies the breast blood.
Venous drainage: Is through the corresponding blood vessels into the interior mammary and axilliary vein.
Lymphatic drainage: Is into the axilliary glands and into the portal fissures of the liver. The lymphatic vessels of each breast communicates with one another
Nervous supply: The functions of the breast are largely controlled by hormone activity but the skin is supplied by branches of the thoracic nerves and there are some sympathetic nerve especially around the areola and the nipple. Its major function is to store breast milk and supply the baby with milk.
Mastitis
Mastitis which is simply an infection of the breast, usually affects one breast at a time. A tropical example of types of mastitis is illustrated on the diagram below according to Davis (2008)
According to Davis (2009) there are four verities of mastitis. They are:-
- Parenchymatous or inflammation 0f one or more lobes of the breast.
- Periglandular cellulities or phlegnmonous mastitis- this occurs when the fat and loose tissues between the lobes are inflamed.
- The inflammation that may be in the areola or a little abscess may form in one of the Montgomery tubercles.
- Submammary abscess this results when the infection spreads through the breast to the underling tissues, which fastens the breast to the chest wall
This types of mastitis can thus be summarized into two major types (2010)
- The non – infection tubercles.
- The infective mastitis.
- The non- infective mastitis:- This result from milk stasis usually within the first five days of peuperium due to the baby’s inability to suck effectively to empty the breast resulting to breast engorgement which if not resolved makes the breast to be tender. This tend to be acute.
- Infective mastitis:- This results when pathogenic micro- organisms or normal floral around the nipple gain entrance into the breast through a crack or sore on the nipple. The organisms multiply to form abscess infective mastitis which tends to be chronic.
Causes of mastitis
- Poor application of the baby’s mouth over the areola.
- Frequent sucking.
- Supplementary or complementary feeding
- Baby sleeping all through the night
- Pressure on the breast from prone position.
- Wearing of tight breast binders
- Staphylococcus aureus
- Staphylococcus albicans
- Escherichia coli
Pathophysiology of mastitis
According to Myles (2009) poor application of the baby’s gum on the areola makes the baby to masticate the nipple. Persistent chewing of the nipple will lead to cracking of the nipple to painful nipple. Because of fear of the pain, the mother will not want the child to suck from the affected breast leading to stasis, which will lead to engorgement of the breast. This engorgement is usually within the every part of the breast which will make the tissues to be congested. This congestion will press on nerve ending leading to pain, tenderness, warmth. Further production of milk lead to the see – page of breast milk into the blood stream leading to chills and malaise feeling. If there is no prompt emptying of the breast together with the presence of micro – organisms, their multiplication takes place damaging surrounding tissues leading to suppuration (abscess formation).
Signs and symptoms of mastitis
- Crack/sore on the nipple
- Erythermer
- Pyrexia
- Pains
- Painful lymph nodes
- Chills
- Malaise
- Headache
Complications
- Breast abscess to the mother
- Malnutrition to the child
Epidemiology
It is common with every breast feeding mother but commoner with the primiparas usually in the first five days of peuperium.
Prevention of mastitis
- Health education of pregnant mothers on how to care for the nipple during antental clinic.
- Post partum teaching of the mother on how to put baby to breast by making sure that the baby’s mouth is on the areola and not the nipple during every feed.
- Baby should feed on the engorged breast first and empty it before sucking from the unaffected breast.
- The mother should drink plenty of fluids to reduce the milk viscosity
- Breast feed baby on demand to drain the breast
- Apply hot compress on the breast to dilate the lactiferous duct for easy flow of breast milk.
- Gently message the sore nipple with Vaseline
- Express the breast milk for the baby if the breast is so painful
- Take antibiotics as prescribed
- If with all the above measures, there is no improvement, there may be abscess; incise and drain or refer to a doctor.
References
Allan H. (2004) Current Obstetrics and Gynaecologic Diagnosis and Treatment 7th Edition Oxford University Press New – York
Denise T. (2004) Biller’s Midwives Dictionary, 6th Edition Edinburg Churchill Living Stone London UK
David W.(2007) Where there is no Doctor. A village Health Care Hand Book 7th Edition, Macmillam Education Ltd.
Davis R. (2008) De Lee’s Obstetric for Nurses, 3rd Edition Edinburg Livingstone London
Dianne M.F (2009) Myles Textbook for Midwives, 15th Edition Livingstone London
Maurine K.MD (1993) Primary Surgery Volume One, Low Priced United State, New York
Nancy Di.D (2005) A Text Book for Midwives 4th Edition Living Stone .
Ojo, (2006). A Textbook for midwives in the tropic, 7th Edition port –Hon Court
Klein S. (2003) Book for Midwives, 2nd Edition Low Priced United State, U.K.