A published article by Dr. Carmela Baez brings new insight to breast pain, chronic mastitis, and mastalgia (2016). The management for acute mastitis is clear, but there is little scientific evidence to support management of chronic breast pain and mastitis. Many terms have been used to describe this maternal situation, such as breast pain, deep breast pain, chronic breast inflammation, and chronic mastitis. Current literature does not, however, provide clear definitions for these terms.
Baeza states, "...chronic mastitis refers to a lasting breast pain with no evidence of acute inflammation, such as erythema, warmth, or induration. The pain is described in various ways, often as deep, shooting pain, or burning sensation in one or both breasts that may happen during or between feeds" (p 11). The medical term for breast pain is mastalgia, as mastitis suggests inflammation or infection. Mastalgia causes cannot always be ascribed to breastfeeding difficulties, since it can also be found in non-lactating women, described as drawing, burning, achy, and sore.
What might some of the causes be for mastalgia?
For many years, lactation professionals believed much of the mastalgia was caused by Candida albicans. However, more recent studies have brought this belief into question, and raised many more questions.
S. epidermidis has been found to have very strong activity against E. coli, S. aureus, and listeria monocytogens. Since the milk content of each mother varies, and in the same mother, varies between feedings, should culturing milk be routine? Current research suggests culturing be done only for women with lactational mastalgia who do not respond to good lactation management, support, and comfort measures.
Are probiotics, whose use has risen dramatically in recent years, helpful or harmful? Manufacturers are advertising probiotic use for prevention and treatment of mastalgia and mastitis. The research shows only one study, Arroyo et al., 2010, that suggests less pain in women to took the products. The study is not blinded, has no control group, and has other study flaws, so the results can be called into question.. Interestingly, Baeza points out that lactobacilli and bifidobacteria in human milk is fairly low. What does increasing those levels artificially do to the microbiota of breast milk?
When an infant/child breastfeeds, there is a retrograde flow of saliva into the breast. Baeza questions, "How does frequent milk removal change the mother's microbiota? Why are some microbes pathogenic for some mothers but not for others? Does the child's microbiota regulate the mother's and in what way? What do the changes we observe in each mother's microbiota mean? Is the mother protecting the child or vice versa? Why do some mothers have a changing microbiota, whereas others have a stable one? Would we see the same variability or stability in their babies' saliva microbiota? Are we looking at a response to the environment or to changes in mother or baby's immunological state?" (p 14).
This is an extensive article with a great deal of information contained within. The full page chart on management of lactational mastalgia is very helpful to International Board Certified Lactation Consultants (IBCLC). To close, I want to quote Baeza one last time: "The dynamic balance of human milk depends on the interaction of its difference components, and of this system with the mother as a whole: her genetic, immunological, physiological, and demographic characteristics and the interaction with her infant's microbita", (p 14).
Kathy Parkes, MSN-Ed, BSPsy, RN, IBCLC, RLC, FILCA
Professional Development Educator, Step 2 Education International
Baeza, C. (2016). Chronic mastitis, mastalgia, and breast pain: A narrative review of definitions, bacteriological findings, and clinical management. Clinical Lactation; 7(1):5-10. http://dx.doi.org/10.1891/2158-0718.104.22.168
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