Mastitis is the inflammation of breast tissue, affecting both breastfeeding and non-breastfeeding individuals. It is a common concern among breastfeeding parents, impacting approximately 1 in 10 in the U.S., typically within the first one to three months after childbirth. Recognizing subacute mastitis, a more subtle form, is important for timely management.
Understanding Subacute Mastitis
Subacute mastitis is a type of breast inflammation that differs from acute mastitis in its presentation. Unlike acute mastitis, which often appears suddenly with prominent symptoms like fever and significant redness, subacute mastitis has a more gradual onset. Symptoms are generally less severe and may not include overt signs of infection, such as a high fever or widespread redness and swelling. This form can persist longer than acute mastitis but typically does not become chronic. It may occur with or without low-grade bacterial involvement.
Recognizing the Signs
Symptoms of subacute mastitis are often subtle and can be mistaken for other conditions, such as nipple thrush. Individuals may experience a stinging or prickling sensation in the nipple, especially at the beginning of a feeding or immediately afterward. Pain in the breast, sometimes described as sharp or shooting, can also occur and may extend towards the ribs. Nipple blebs, which are small, painful white dots on the nipple caused by a blocked milk duct, or wounds that do not heal readily, are common indicators. Unlike acute mastitis, there is often an absence of widespread redness, significant swelling, or fever.
Causes and Contributing Factors
Subacute mastitis often arises from issues related to milk removal and the balance of bacteria within the breast. Ineffective or infrequent milk removal (milk stasis) can contribute by allowing milk to accumulate in the ducts. Nipple damage, such as cracks or soreness, can provide an entry point for bacteria from the skin or an infant’s mouth to enter the milk ducts. An imbalance in the breast microbiome, specifically an overgrowth of Lactobacillus fermentum and Lactobacillus salivarius, can lead to the formation of biofilms that narrow milk ducts and impede milk flow. Factors like a shallow latch during breastfeeding, tight clothing, or stress can also contribute to milk stasis and subacute mastitis.
Diagnosis and Treatment
Diagnosis of subacute mastitis primarily relies on a thorough clinical examination and a detailed review of symptoms. While milk cultures may sometimes be taken, they often yield negative results or show normal bacterial flora. A healthcare professional should be consulted for an accurate diagnosis, as some symptoms can overlap with other conditions, including inflammatory breast cancer, which requires different management.
Treatment for subacute mastitis focuses on reducing inflammation, improving milk flow, and addressing any underlying bacterial imbalance. Optimizing milk removal through improved latch techniques and frequent feeding or pumping is a primary approach. Anti-inflammatory medications, such as ibuprofen, can help manage pain and reduce swelling. In some cases, specific probiotics, particularly Lactobacillus fermentum and Lactobacillus salivarius, have shown promise by helping to restore the breast’s bacterial balance. If a bacterial infection is suspected or confirmed, a course of antibiotics may be prescribed, typically for about 10 days.
Preventing Recurrence
Preventing the recurrence of subacute mastitis involves consistent attention to breastfeeding practices and overall breast health. Ensuring effective and frequent milk removal is paramount, meaning the baby should fully drain one breast before the second, and feeding on demand (typically 8 to 12 times within 24 hours). Proper latch during breastfeeding is important to prevent nipple trauma, which can create entry points for bacteria; a creased or misshapen nipple after feeding may indicate a shallow latch needing adjustment. Avoiding restrictive clothing or bras that put pressure on the breasts can help prevent milk stasis. Maintaining good overall health, including adequate rest and nutrition, supports breast health and resilience.