Mastitis (Inflammation of the Mammary Glands): Specialists & Information

In general, medical professionals define mastitis as an inflammation of the mammary gland (breast). It is most often caused by bacteria.

Depending on the cause, two different forms of mastitis are distinguished:

1. Puerperal mastitis (occurs in mothers shortly after childbirth)
2. Non-puerperal mastitis (not associated with pregnancy)

The condition is generally more common in women than in men. It primarily affects breastfeeding women. Puerperal mastitis often leads to the early termination of breastfeeding between mother and child. Mastitis with other causes is relatively rare in comparison and is therefore often suspected to be tumor-related.

In the majority of cases, mastitis is caused by bacterial pathogens on the skin or mucous membranes. These pathogens colonize the skin and enter the mammary gland, for example, through tiny skin abrasions. The most common pathogens are:

• Staphylococcus aureus,
• streptococci, and
• Pseudomonas sp.

The bacteria are usually transmitted to the irritated nipples during breastfeeding. From there, they travel through the milk ducts into the mammary glands, where they cause inflammation and, in severe cases, an abscess.

Minor injuries during breastfeeding, as well as milk stasis within the mammary glands, promote the development of the condition. Milk stasis provides an ideal breeding ground for bacteria.

In addition, hormones, medications, or stress can lead to increased secretion production in the mammary glands. This triggers an immune response, resulting in inflammation.

Classic mastitis primarily causes flu-like symptoms, such as 

• fever,
• headaches, and
• body aches

and, depending on the severity of the inflammation in the breast, typical signs of inflammation:

• heat (calor),
• redness (rubor),
• pain (dolor), and
• swelling (tumor).

There may also be discharge from the nipple. In some cases, there may also be a palpable swelling of the lymph nodes in the armpits.

If you experience these symptoms, see a doctor. Swollen lymph nodes and breast pain can also indicate other conditions, such as breast cancer.

The findings should therefore generally be medically evaluated through differential diagnosis using ultrasound or mammography, as well as a biopsy.

Furthermore, if left untreated, mastitis can also develop into an abscess (= a pus-filled swelling).

Mastitis involves inflammation of the mammary glands © koyuki | AdobeStock

The medical history already provides initial indications of inflammation in the breast. The doctor asks the patient about their symptoms. The doctor then usually palpates the affected breast.

The diagnosis of mastitis is confirmed using imaging. This is particularly necessary

• in cases of mastitis with no apparent cause or
• if the inflammation proves to be persistent despite treatment.

In these cases, other causes—including cancer—must be ruled out.

The diagnostic process also includes palpation of the breast © romaset | AdobeStock

The first line of treatment for mastitis is to apply cold compresses and rest the affected breast for a while.

Bacterial mastitis is treated with antibiotics. Antibiotic therapy is usually systemic, meaning that affected women take the medication in tablet form. The antibiotics most commonly used are

• cephalosporins,
• clindamycin,
• alternatively, flucloxacillin plus metronidazole, or
• oxacillin,

are used. 

If left untreated, this type of bacterial inflammation can lead to complications, such as the formation of an abscess. If a painful collection of pus has already developed, it is surgically incised and the pus is then drained. This is medically referred to as drainage.

Nonbacterial mastitis is usually treated with prolactin inhibitors. These are intended to stop or resolve the milk stasis. If successful, women are symptom-free again within a few days of starting treatment in the majority of cases.

The S3 guideline on the treatment of inflammatory breast diseases during breastfeeding is also currently being updated to reflect the latest research. It includes recommendations regarding the effectiveness of alternative methods as a supplement to conventional medical treatment. However, there is usually very little to no scientific evidence supporting these approaches. 

Certain everyday factors can contribute to mastitis. These include, among others:

• Smoking,
• injuries to the skin of the breast, e.g., from a piercing,
• medications, such as ovulation inhibitors with a high estrogen content,
• thyroid disorders,
• stress, tension, and
• breastfeeding errors.

The best prevention is proper breastfeeding technique. The way the baby is latched on and the sucking technique must be adjusted to prevent injuries and irritation to the nipples. Otherwise, these injuries often serve as the initial entry point for the bacteria that cause mastitis.

You should also practice using breastfeeding aids, such as breast pumps and nipple shields. Treat sore nipples.

Seeking medical attention early, followed by prompt treatment, significantly improves the prognosis. Waiting too long allows the inflammation to go untreated and fully develop.

If left untreated, serious complications—such as painful abscesses—can quickly develop. These, in turn, may require surgical intervention. Furthermore, any surgery carries new risks of infection and scarring. Recovery can therefore be a lengthy process.

The first point of contact for women with mastitis is

• the family doctor,
• the midwife (for new mothers),
• the gynecologist.

In the event of complications, such as an abscess, surgeons may also be involved.

In rare cases, men can also develop breast inflammation. For them, the urologist and the andrologist are the first points of contact. If a man experiences lumps or pain in the breast—but especially if there is discharge or inverted nipples—he may also have breast cancer.