AWMF Guideline Also Available for Breastfeeding
This is an important contribution—the topic often comes short, is almost overlooked, when taking into account the frequency of publications on breast cancer (1).
The AWMF S3 Guideline on breast cancer is mentioned, but strangely enough not the AWMF S3 Guideline on the “Treatment of Inflammatory Breast Disease during the Lactation Period” (2), which for the first time gives a very good summary of this topic.
Milk stasis should be distinguished from puerperal mastitis. Usually it only becomes evident after some time that mastitis is present. The drug of choice is not paracetamol but rather ibuprofen, up to 2400 mg/day (3), as it has analgesic and antiphlogistic effects. Applying local warmth prior to breast feeding is not always conducive and is even outdated for initial breast engorgement. Cooling (at refrigerator temperatures) immediately after starting to feed is also recommended in the guideline (2), as is frequent breastfeeding. Alternatively, pumping is an option if breastfeeding is too painful for the mother. Milk can also be extracted by hand; however, “massaging out” the milk is strongly unadvisable as this can strain the tissue. If no improvement is seen after 48 h of symptomatic therapy, a 10–14-day course of antibiotics should begin, as described (1). Breast ultrasound is part of the diagnostic standard if symptoms are persistent. This can detect for example an abscess at an early stage, which then needs to be treated with the current gold standard of abscess puncture.
As emptying the breast is part of the therapy, weaning (at the request of the patient) is a treatment option only after symptoms have resolved. Secondary weaning by prolactin inhibitors has no time advantages. The side effects of the prolactin inhibitors need to be considered. Bromocriptine for weaning has been taken off the market.
The best prophylaxis is to assure a proper latch, avoiding sore nipples, and using evidence-based wound management. Breastfeeding should receive adequate support right from the start, which unfortunately is not always sufficiently ensured by midwives.
Dr. Gabriele Kußmann, IBCLC
Gudrun von der Ohe, IBCLC
|1.||Stachs A, Stubert J, Reimer T, Hartmann S: Benign breast disease in women. Dtsch Arztebl Int 2019; 116: 565–74 VOLLTEXT|
|2.||Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (AWMF 015/071): S3-Leitlinie Therapie entzündlicher Brusterkrankungen in der Stillzeit. www.awmf.org/uploads/tx_szleitlinien/015–071l_S3_Therapie_entz%C3%BCndlicher_Brustentz%C3%BCndungen_Stillzeit_2__2013–02-abgelaufen.pdf (last accessed on 27 September 2019).|
|3.||Schaefer C, Spielmann H; Vetter K Weber-Schöndorfer, C: : Arzneimittel in Schwangerschaft und Stillzeit. 8. edition. München: Elsevier 2012.|