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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The initial presentation is that of a diffuse cellulitis which localises into an abscess after several days.

The patient may be generally unwell with flu like symptoms (chills, headaches, muscle aches) and a spiking fever. The affected area of the breast is painful and tender, red and warm (1). There may be a purulent discharge if the lesion is extensive.

It is difficult to clinically differentiate between non infectious mastitis and infectious mastitis (1).

  • infectious mastitis
    • usually a part of a breast becomes red, painful, swollen and hard
    • there may be general symptoms like fever and malaise
    • a nipple fissure is present
    • improvement of symptoms do not occur (after 12-24 hours) even after effective milk removal
  • full breast
    • seen between the 3rd and 6th day after delivery
    • the breast feels hot, heavy and hard, seen in both breasts
    • the breast is not shiny, oedematous or red
    • the milk may sometimes drips out spontaneously
    • resolves once the infant removes the milk by effective suckling
  • engorged breast
    • the breast is enlarged, swollen and painful
    • may present as oedematous, shiny with diffuse red areas
    • the nipple might appear flat due to stretching
    • milk does not flow out easily and the infant may find it difficult to attach and suckle due to the swelling
    • the women usually presents with fever which subsides within 24 hours
  • blocked duct
    • presents with a painful lump in the breast with an overlying patch of redness on the skin
    • the patient usually feels well and does not have a fever
    • expressed breast milk may contain white particulate matter
    • there may be associated “white spot” at the end of the nipple (around 1mm in diameter) which is extremely painful during feeding
  • breast abscess
    • presents with severe pain and a swollen lump in the breast, the overlying skin may be red, hot and swollen
    • the lump may be fluctuant and there might be skin discolouration and necrosis
    • the patient may or may not have fever

Reference:


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