Management of Mastitis

Mastitis is an inflammation of the breast tissue that causes swelling and pain in the breasts due to bacteria entering through the crack on the skin surface around it. Occasionally, breast cancer may also appear to resemble mastitis and it is advisable to see a doctor if the symptoms do not resolve with appropriate treatment. Dr Lee Wai Peng, our Senior Consultant and Breast Surgeon sheds light on the causes and treatment of mastitis. What is Mastitis? Mastitis refers to the inflammation of the breast tissue, most often caused by an infection. What causes mastitis? Lactating women are at risk of developing mastitis. Milk that is retained in the breast is the main cause for mastitis in lactating women. Bacteria from the skin surface of the breast or from the baby mouth may enter the milk duct through a crack in the skin of the nipple or through an opening in the milk duct, giving rise to infection. Who are at risk of developing mastitis? Women who are breastfeeding are at risk of developing mastitis. Engorgement and incomplete breast emptying can contribute to the problem and make the symptoms worse. It can happen anytime during lactation, but it is more common in the first three months of lactation. Up to 10% of breastfeeding women may be affected. Less commonly, women who have poorly controlled diabetes mellitus or are immunocompromised may be at risk of developing mastitis. In some women, the underlying cause may be unknown. This condition is called idiopathic granulomatous mastitis (IGM). In severe cases of IGM, steroid therapy may be advised if an infection has been excluded. What are the symptoms of mastitis? The inflammation causes pain, swelling, warmth, and redness. You may even develop fever and/or chills. Occasionally, breast cancer may appear to resemble mastitis. Please do see a doctor if your symptoms do not resolve with appropriate treatment. Can mastitis resolve on its own? Mastitis may sometimes resolve on its own especially if it is mild. However, a short course of antibiotic treatment is warranted in most instances. Breast abscess, which is a serious complication of mastitis, may develop. Apart from antibiotics, a surgical drainage procedure may be necessary to treat this condition. When do I need to consult a doctor? It is advisable to consult a doctor if you have any of the symptoms and to start treatment early. Treatment comprises pain killers (some of which might be anti-inflammatory) and a short course of antibiotics. If you are lactating, please be reassured that you can continue to breastfeed. Mastitis does not increase your risk of developing breast cancer but inflammatory breast cancer may occasionally resemble mastitis. Please do see your doctor if your symptoms do not resolve with appropriate treatment. Apart from taking medications, are there any home remedies or/ lifestyle modification that one can consider? If you are lactating, please do ensure that you empty your breast at regular intervals. Your breast milk supply may drop during this period of infection but it should increase again once you recover. Applying warm moist compress over your breast regularly or ice pack after breastfeeding may help to improve your symptoms. You may feel tired due to the infection and may have to rest more during this time. A supportive bra (such as a sports bra) may also help to alleviate the discomfort that you are feeling. Article contributed and reviewed by Dr Lee Wai Peng, Senior Consultant and Breast Surgeon at Solis Breast Care & Surgery Centre.
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What Do Dense Breasts Have to Do with Breast Cancer?

Upon learning that breast density is linked to an increased risk of breast cancer, many women will be quick to check by touch or appearance if their breasts are dense. Unfortunately, breast density can only be confirmed with an imaging examination. Dr Lim Siew Kuan, our Senior Consultant and Breast Surgeon, shares more about some of the characteristics of dense breasts and how they relate to breast cancer. What are the Characteristics of Dense Breasts? A breast contains varying amounts of fibrous, glandular and fatty tissue. To be considered dense, a breast should have less fat and more glandular and fibrous tissue than is expected. It is also worth noting that dense breasts are more commonly found in young women (premenopausal) as well as older women (postmenopausal) taking hormone therapy to address symptoms of menopause. The four main categories of breast density include: Category A: Breast is composed almost entirely of fatty tissue Category B: Breast has scattered areas of fibroglandular density Category C: Breast has a mix of fibroglandular and fatty tissue, also known as heterogeneous density Category D: Breast has extremely dense tissue with little to no fat Understanding the Link Between Breast Density and Breast Cancer To this day, the reason for why dense breasts increase the risk of breast cancer is undetermined. However, certain metrics reveal why breast density is cause for concern. For some context: Oral contraceptives increase breast cancer risks for women 40 – 49 years old by 1.3 times. Heterogeneously dense breasts increase the risk by 1.2 times. Extremely dense breasts increase the risk by 2.1 times. And having a first-degree relative diagnosed with breast cancer before the age of 40 increases the risk by 3.0 times. Taken as a whole, breast density is a risk factor, but it is certainly not the biggest.A family history of breast cancer, a previous personal history of breast cancer or high-risk breast lesions, as well as hereditary mutations in the Breast Cancer (BRCA) genes are more important risk factors than breast density. Challenges in Mammogram Diagnosis Dense breasts pose a significant challenge when looking for traces of cancer. On a mammogram, dense tissue is presented as a white area, but so too is breast cancer. The challenge for doctors exists in interpreting the mammogram, as cancer may be hidden under the guise of dense breast tissue. Nonetheless, mammograms are still the ideal choice for women with dense breasts; anecdotal evidence reveals that mammograms are more accurate than other diagnostic tests and can detect most types of breast cancer. Alternative Diagnostics A combination of mammography and breast ultrasound is frequently used to increase the detection of breast cancer for women with dense breasts. The addition of ultrasound allows the visualisation of small breast lesions, which may be obscured by dense tissue on mammograms. Digital breast tomosynthesis (3D mammogram) is now widely available and is preferable to 2D mammography in screening women with dense breasts. It gives improved sensitivity for cancer detection, while decreasing the false-positive rates. Breast Magnetic Resonance Image (MRI) has also emerged as another excellent imaging modality, and may be used for further assessment when both mammography and ultrasound are non-conclusive. The benefit of using MRI is that, unlike mammograms, dense breast tissue does not affect imaging results. However, the downside is an increased likelihood of false positives. Due to its high sensitivity, MRI screening is also recommended in women with a high lifetime risk of developing breast cancer. Recommendations If tests conclude you have dense breasts, try not to worry too much, a discussion with a breast specialist will reveal what options are available to you based on your medical history and any other relevant factors. Yearly mammogram screening is advised, but for a more conclusive result, an ultrasound, breast MRI or even genetic testing may be recommended by your doctor. If you have discovered some signs and symptoms of concern, schedule an appointment with our breast specialists for medical advice on what are the best steps to take. Article contributed and reviewed by Dr Lim Siew Kuan, Senior Consultant and Breast Surgeon at Solis Breast Care and Surgery Centre.
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