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Table 3 Thematic responses of physiotherapists – clinical definition and diagnosis of ICLB

From: Exploring physiotherapists’ clinical definition and diagnosis of inflammatory conditions of the lactating breast in Australia: a mixed methods study

Theme 1: The clinical definition of ICLB varies and may be based on its diagnostic symptoms and/or pathophysiology, or may include breast conditions

Subtheme 1.1: Definition of ICLB based on local and systemic clinical signs and symptoms presented by the patient

May consist of redness, increased temperature of affected area, tenderness on palpation, palpable lump, and fever or flu like symptoms (P1)

Swelling, lump, pain and or redness over part of one or both breasts in the breast feeding woman (P45)

Subtheme 1.2: Definition of ICLB based on pathophysiology/cause

Pressure on milk ducts that has caused breast milk to leak into surrounding breast tissue and cause an inflammatory response. The body’s response to these “injuries” is usually quite extreme. (P4)

When milk stasis occurs in a duct … chemicals unique to the milk can seep out of the semi permeable membrane of the duct into the parenchymal tissue. As this chemistry is foreign to the body outside the duct - an immediate, often severe inflammatory process is triggered (P2)

Subtheme 1.3: Definition of ICLB using breast conditions

‘Non-infective mastitis’ or ‘Blocked ducts’ i.e. ICLB (P4)

May include mastitis, milk stasis, breast abscess etc. (P92)

Subtheme 1.4: Definition of ICLB comprised of altered breast function

Inflammation of the breast tissue potentially resulting in impaired milk transfer (P55)

Bothersome deep thickening (lump) of a section or sections of the lactating breast possibly associated with. .. reduced flow of milk from the affected breast (P87)

Theme 2: The diagnosis of ICLB is based on the patient’s presenting signs and symptoms but there is no consensus on the specific number or combination of local symptoms required, or if it includes systemic symptoms

Subtheme 2.1: Diagnosis of ICLB based on the presence of local symptoms only

Breast lump (hard area) + either, tender, red, hot (P2)

Pain or local tenderness, a degree of local tension/swelling (P3)

Subtheme 2.2: Diagnosis of ICLB based on the presence of local symptoms which is often associated with systemic clinical symptoms

Local symptoms including pain, redness, tension; global symptoms such as feeling unwell; plus some difficulty lactating (P4)

Combines with subjective symptoms of feeling unwell, objective assessment needs to include redness, firmness or increased breast tension, and there must be a palpable breast tension/lump/firmness (P96)