>> I remember some wise person on Lactnet saying last summer that one
>> source of mastitis is such damaged nipples through which bacteria enter
>> the breast.
>There is a clear relationship between nipple damage and mastitis.
>Lawrence states that broken skin allows a portal of entry for bacteria. A
>study by Evans & Heads (1995) related nipple damage to 39.8% of cases of
>mastitis, and to 88% of cases of bilatera mastitis in the first two weeks.
>Other studies have also found a positive association. However, "positive
>association" is not the same as "cause". Since increased feeding frequency
>has been shown to be a major protective factor against mastitis, does
>nipple damage cause mastitis because of bacterial entry or less
>effective/less frequent feeds?

OK, I'm now going to stick my proverbial neck out and suggest that bacteria
are not actually involved in mastitis (maybe some, but not as many as is
usually assumed). Shock! Horror!

I really cannot understand how bacteria can get into the damaged nipple and
'swim upsteam' through breastmilk that is full of anti-infective
substances. It just doesn't ring true to me! Does it make sense to you?

I hypothesise that damaged nipples have a positive association with
mastitis because poor attachment and poor drainage actually contribute to
both of these  (as Ros alluded to above). I furthermore hypothesise that
the inflammation associated with mastitis is just that, and not infective.
Inflammation can be caused by the milk being forced out of the ducts and
into the surrounding tissue (which was also mentioned in Ros's post I
think). The reason antibiotics 'work' is that they have an
anti-inflammatory effect.

I would really like someone to sort this out, so that we can stop putting
what seems to me ridiculous explanations into text books on breastfeeding.
Comments, anyone?


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Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Perth, Western Australia.   mailto:[log in to unmask]
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