How to deal with postpartum mastitis?

Patient's question:

My wife developed mastitis in the eleventh week of pregnancy. The nipples became red and swollen, with pus discharge, but there was no bad odor. She had inverted nipples before, and we were worried that taking medication might affect the fetus.

Doctor's answer:

Acute mastitis is an acute inflammation of the breast caused by bacterial infection, often forming an abscess within a short period, primarily due to the invasion of Staphylococcus aureus or Streptococcus along the lymphatic vessels. It is most common in breastfeeding women 2 to 6 weeks postpartum, especially first-time mothers. The bacteria typically enter through cracked or broken nipples or directly cause infection. Although this condition can be effectively treated, it causes pain upon onset, destroys breast tissue, leading to breast deformation, and affects breastfeeding.
Guidelines:
1. Early administration of rest, cessation of breastfeeding from the affected breast, cleaning the nipple and areola, and promoting milk discharge (using a breast pump or suckling) are necessary. If drainage is required, breastfeeding should be stopped.
2. Apply a warm compress with 25% magnesium sulfate locally, along with physical therapy.
3. In the early stages, intracapsular injection of 800,000 to 1,000,000 U of penicillin mixed with 1% to 2% procaine (10 ml) in isotonic saline (10 to 20 ml) can be administered around the lump.
4. Systemic antibiotic use is recommended. To prevent severe infection and sepsis, antibiotics should be selected based on bacterial culture and sensitivity tests. Intravenous antibiotics may be administered if necessary.
5. Chinese medicine: Heat-clearing and detoxifying herbs.
6. If an abscess has formed, it should be drained promptly. The incision is typically radial, centered around the nipple and areola. For superficial abscesses under the areola, an arc-shaped incision along the areola is made. If the abscess is located behind the breast, an arc-shaped incision 1 to 2 cm below the skin fold at the lower breast should be performed.