Mastitis

Lactational mastitis is not automatically a bacterial infection. It is a spectrum that begins with ductal narrowing and inflammatory swelling and may progress to bacterial mastitis, phlegmon, abscess, or galactocele. The central mechanism is alveolar edema. When the milk-producing tissue swells, mammary ducts narrow and milk flow becomes more difficult. Hyperlactation, or oversupply, increases this pressure; disruption of the mammary milk microbiome, called dysbiosis, may further promote inflammation. This is why trying to force out a supposed “plug” with deep massage or repeated pumping can worsen the problem: additional tissue trauma and milk production add to edema rather than opening a blocked pipe. Inflammatory mastitis may produce a painful, erythematous, edematous region of the breast along with fever, chills, and tachycardia. Those systemic findings do not, by themselves, prove bacterial infection. Bacterial mastitis becomes more likely when symptoms persist beyond approximately 24 hours or worsen despite appropriate conservative care, particularly when cellulitis is spreading or the patient is becoming systemically ill. The practical nurse’s clinical reasoning begins with the trajectory. A patient who is uncomfortable but stable and improving after...