Puerperal Mastitis [Puerperale Mastitis]

Determination of the bacterial count can be used to differentiate between puerperal mastitis due to a bacterial infection and non-bacterial mastitis due to breast engorgement. In addition, Candida can cause mastitis presenting primarily with pain, but also with typical desquamative skin lesions. Bacterial mastitis should be treated with antibiotics effective against staphylococci (e.g., cephalosporins, erythromycin), and breast engorgement should be treated with a physical therapy. Dopamine agonists have no value in the treatment of puerperal mastitis if the patient wants to continue breast feeding. New mothers should be informed that early medical treatment of mastitis needs to be initiated as soon as possible after the appearance of symptoms. The likelihood that an abscess will develop increases sharply if two or more days pass without adequate treatment. Abscess puncture can be performed with the simultaneous administration of an antibiotic. If the abscess is large or septated, or if the patient cannot tolerate puncture of the abscess, drainage by submammary incision is indicated. Perimamillary incisions should be avoided. The incidence of puerperal mastitis can be significantly reduced by proper hand disinfection.