MDM - Mastitis

[##]-year-old [breastfeeding] female with [redness/irritation/swelling] of the [right/left/bilateral] breast(s) with history and exam consistent with likely mastitis.

Initial considerations in this patient included mastitis, cellulitis, mechanical irritation of the breast, systemic infectious processes, and necrotizing soft tissue infections among others.

Patient presented with [erythema/swelling/tenderness] of the [right/left/bilateral] breast with associated [fever/chills/flu-like symptoms] concerning for mastitis [in the setting of breastfeeding].  Labs [were/were not] obtained in the evaluation of this patient [based on absence of response to antibiotics after 2 days, recurrent episode of mastitis, hospital acquired mastitis, reported allergy to standard antibiotic therapy, or severe or unusual case/absence of concerning features].  [Labs were noted to be unremarkable/notable for specify.]  A [bedside/formal] ultrasound was obtained with [no evidence of concurrent abscess/evidence of superficial/deep abscess measuring ## cm].  [Given superficial/deep nature of abscess, a needle aspiration was performed under ultrasound guidance/surgery was consulted for further management.]

[The site of cellulitis was marked prior to discharge from the ED with strict return precautions given for evidence of worsening infection.]  We discussed return precautions, specifically for evidence of worsening infection, treatment with [Dicloxacillin/Cephalexin/Clindamycin/Augmentin] and symptomatic treatment, and follow up with primary care doctor within 2-3 days for further evaluation of response to therapy, and the patient demonstrated understanding and agreement.  Prior to discharge, we emphasized the importance of continuing to breastfeed while on antibiotics, and the patient demonstrated understanding and agreement with this recommendation.

Discharge Instructions - Mastitis

As discussed in the Emergency Department prior to discharge, you have been diagnosed with mastitis.  Mastitis is an infection in the breast tissue that most commonly occurs in breastfeeding women.  It usually involves significant swelling as an infection occurs in the breast ducts that drain milk.

Mastitis can occur in the setting of inflammation and obstruction of breast ducts without infection, but it is more commonly associated with a bacterial infection.  Bacteria (usually Staphylococcus aureus) commonly enter through a crack or break in the skin or nipple.  In many cases the bacteria causing mastitis is from the mouth of the breastfeeding infant.

It is important that you continue to breastfeed through mastitis, as this will help drain blocked breast ducts and decrease inflammation and swelling.  Your infant is extremely unlikely to catch this infection by continuing to breastfeed and the benefits of breast milk far outweigh any risks.  If you choose not to breastfeed your infant, it is important that you continue to pump breast milk to at least promote drainage.

Make sure that you take your prescribed antibiotics as directed, for the full course (don’t stop early).

Acetaminophen (also known as Tylenol) an over-the-counter medication can assist with discomfort, and is safe to take while breastfeeding according to the dosing instructions on the package.  You can also massage the breast after feedings to help decrease swelling.  You can also apply ice to the breast after feedings for about 10 minutes to help with discomfort and swelling.

Return to the Emergency Department if the pink or red area on the breast is not smaller by day two after starting antibiotics, you see a red streak going up the breast after starting antibiotics, drainage of pus or foul smelling fluid from the nipple, you develop a new fever (≥38.0 °C or 100.4 °F) or a fever that hasn’t resolved by day two of antibiotics, or for any new or concerning symptoms.