Mastitis occurs in approximately 10 percent of U.S. mothers who are breastfeeding, and it can lead to the cessation of breastfeeding. The risk of
mastitis can be reduced by frequent, complete emptying of the breast and by optimizing breastfeeding technique. Sore nipples can precipitate
mastitis. The differential diagnosis of sore nipples includes mechanical irritation from a poor latch or infant mouth anomalies, such as
cleft palate or bacterial or yeast
infection. The diagnosis of
mastitis is usually clinical, with patients presenting with focal tenderness in one breast accompanied by
fever and malaise. Treatment includes changing breastfeeding technique, often with the assistance of a lactation consultant. When
antibiotics are needed, those effective against Staphylococcus aureus (e.g.,
dicloxacillin,
cephalexin) are preferred. As methicillin-resistant S. aureus becomes more common, it is likely to be a more common cause of
mastitis, and
antibiotics that are effective against this organism may become preferred. Continued breastfeeding should be encouraged in the presence of
mastitis and generally does not pose a risk to the infant. Breast
abscess is the most common complication of
mastitis. It can be prevented by early treatment of
mastitis and continued breastfeeding. Once an
abscess occurs, surgical drainage or needle aspiration is needed. Breastfeeding can usually continue in the presence of a treated
abscess.