On the subject of recurrent mastitis, I have to say that I am convinced that
history taking -- asking good detective questions -- is critical in these
instances.  For instance, I have a primip client who came to see me on MD's
referral after 3 incidents of mastitis at approx 1 mo intervals.  The first
and current incidents are being treated with antibiotics.  The first
incident happened at 5 wks pp and the woman got so sick and had such poor
response to oral meds that she needed iv meds in emer. room, after which she
quickly recovered.  The 2'nd incident she self-treated with typical methods
(bed rest, freq. emptyting, etc)  All three incidents have occurred in the
same spot on the left breast in the inner quadrant at about 9-11 o'clock,
closer to the breast bone than the nipple. This time there is a similar
tender area mirrored on the other breast at 2-3 o'clock.

These are the relevant factors:
She initially had a copious milk supply.  She returned to work part time at
4 wks pp.  She uses a Mini-electric at work to pump, which she says is
uncomfortable, and she thus delays using it.  She is a marathon runner,
doesn't drink, smoke, do drugs, and is typically very healthy.  She gets
frequent Sweedish massages to manage stress.  No sx of secondary candida.
Nipples intact.

What I think is happening:  She has a problem with good breast drainage
which is compounded by her dislike of her pump, and her tendency to delay
using it until she is over-full.  She lies on her stomach to get massages.
The last incident occured the evening after she got a massage. She went to
the mall after the massage, where she pumped with a hand pump in her car
before shopping for 3 hrs. I think the breasts got squashed, bruised, and
then the retained milk which the hand expression failed to remove triggered
an inflammatory response.  Shes been on meds for 4 days, and while better,
is not resolved.  The antiinflammatory effects of antibiotics are terrific,
and are probably helping, but she is still recovering from the trauma.  Also
of concern to me is the red flag that the tenderness is always in the same
spot.  I have ref. her to her OB about this.  Amazingly, she has never been
seen by a doctor for any of this (except for the ER doc who did the iv
treatment at 5 wks pp.)  All tx has been over the phone(!)

What I have told her to do:  I rented her a fully automatic pump to use to
better and more comfortably drain her breasts at work.  I told her to lie on
her side while being massaged.  I suggested she dicontinue running for a
while -- or at least double-bra to better support her breasts.  I told her
to have a doctor look at her to rule out underlying breast disease.  In
general she needs to be more attentive to the degree to which she drains her
breasts until her breasts "calm down."  I will follow up to make sure all is
well.

Why am I boring you with all this?  Mainly because its too simple to say
that some one factor like, for example, ductal yeast is causing this.  Yes
that happens, but there can be mechanical causes for things, and if you keep
asking questions about how people live, what preceeds their episodes of
breast inflammation etc. you may find out the predisposing factors which
then you can manage.  Prevention is still worth a pound of cure.
Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html