A New Approach to Treating Mastitis

by Jenna Congdon, RN, BSN brightsidewriting.com

Feeding your new baby doesn’t seem like it should be complicated, but sometimes it can be. Mastitis is a painful inflammation of the breasts that can happen during lactation. This condition starts with swelling, discomfort, and discoloration in one or both breasts, but it can sometimes escalate into a bacterial infection. If the root cause of the infection is not addressed, it can return again and again.

The preferred treatments and preventative measures for mastitis have changed in recent years, as new studies show us the best way to manage this uncomfortable condition. Let’s cover what to do, what not to do, and when to seek help if you suspect you have mastitis. 

What is Mastitis?

Breasts are made of many small lobes, which produce milk, and microscopic tubes called ducts, which carry milk to the nipple. Mastitis happens when the breast tissue becomes inflamed, which puts pressure on the ducts and blocks the flow of milk. This can happen when the breasts become engorged, when the breast is infected, or even from tight bras or straps pressing on the breasts. 

Mastitis can also occur when an oversupply of milk puts too much pressure on the ducts. An oversupply of milk may happen if you’re pumping too frequently, pumping extra to build a freezer supply of milk, if your baby is not latching correctly while feeding, or if your baby is not nursing as often as they usually do. Infections can happen when the nipples are cracked and bacteria enters through the skin, although this is less common. 

The first sign of mastitis is often a hard, sore lump in your breast. Symptoms include pain, swelling, warmth, and discoloration of the skin. The area may appear red, pink, or darker brown, depending on your skin tone. You may feel achy, tired, or like you have the flu. You might also get a fever. 

If you notice these symptoms, it’s best to start treatment right away. There are remedies you can try at home, but don’t wait for symptoms to get worse before talking to your primary care doctor or a lactation consultant, or reach out to us at The Midwest Center for Breastfeeding and Postpartum Medicine.

What’s Changed About Mastitis Treatment?

Previous Guidelines

The way we treat mastitis has changed recently. In the past, lactating parents experiencing mastitis were told to pump or nurse very frequently and put the baby on the affected side, with the goal of emptying the breast or chest entirely. We now know that this can sometimes make the problem worse. Remember that milk is produced on a supply-and-demand basis. The more you nurse or pump, the more milk your body produces. When you fill your already-sore breasts with extra milk, this puts additional pressure on the inflamed area. This can make the pain and swelling associated with mastitis worse. Instead, nurse your baby as you normally do.

Parents were also told to massage or use vibration on the affected breast, with the goal of relieving clogged milk ducts. However, ducts aren’t exactly pipes needing to be unclogged. They’re tiny tubules, so the problem happens when the surrounding tissue gets swollen and causes them to collapse. Aggressively massaging or vibrating the area further aggravates the swelling, which makes your symptoms worse. Instead, opt for very gentle lymphatic massage to get milk moving through clogged ducts. 

Conventional wisdom tells nursing parents to apply warm compresses to the affected area. Now, we suggest the opposite: cold application decreases the swelling and discomfort better than heat. Placing cabbage leaves on the sore breast used to be a popular remedy. Now, we know that the cool leaves soothe the pain, but that cabbage can carry unwanted bacteria. It’s been to stick to cool washcloths or an ice pack wrapped in a clean towel.

Avoid applying topical ointments like lanolin or drying soaps to the nipple. This can cause cracks and blisters. These small, open wounds can cause an infection. Talk with your healthcare team about safe alternatives if you need something to soothe sore nipples.

Antibiotics used to be offered early and often for mastitis. This is no longer the case. Mastitis isn’t always an infection; it can simply be painful inflammation. If there is not a bacterial infection, antibiotics will not help. Ask your doctor if your case of mastitis requires antibiotics or not. 

The Updated Approach: Mastitis Is a Spectrum

Recently, healthcare providers have shifted to understanding mastitis as a spectrum. On one end, a clogged duct (otherwise known as milk stasis) can cause a hard, painful lump in the breast. This can advance to inflammatory mastitis, when the breast is swollen, discolored, and increasingly painful. You may develop flu-like symptoms or feel ill. This is not an infection, and does not require antibiotics. 

Bacterial mastitis happens when bacteria enters the breast, such as through a crack in the nipple. This is an infection, and your doctor may prescribe antibiotics. Rarely, an abscess may develop. An abscess is a collection of pus inside the breast. If you have an abscess, your doctor may want to drain it. This is done by using an ultrasound machine to look for the abscess inside the breast, and then inserting a needle to drain the pus. Even if you’re taking antibiotics or have an infection, it’s safe for baby to nurse. Mastitis isn’t contagious, and you can’t give your baby an infection by nursing them while you have it.

Tailoring Antibiotic Use

Patients and healthcare providers have a responsibility to be careful about how they use antibiotics. If you get a prescription for antibiotics, take the entire bottle in exactly the way they were prescribed. Do not stop taking them just because you feel better. To get rid of all the harmful bacteria, you need to take every pill until the bottle is empty. If you miss a few doses or don’t take them all, this creates antibiotic-resistant types of bacteria. Likewise, taking antibiotics when they’re not necessary encourages antibiotic-resistant bacteria to grow. These resistant bacteria can lead to more dangerous infections in the future, and make treatment for infections much harder. Talk with your doctor about if you need antibiotics for your mastitis. If you do, please be sure to take them as prescribed.

Your doctor may wait a day or two before prescribing antibiotics for your mastitis, to cut down on unnecessary antibiotic use. Generally, they will write a prescription if your symptoms don’t get better after 24 hours of other treatments, if you have a persistent high fever, or if they suspect you have a bacterial infection.

Ouch! What to Do When Mastitis Hurts

Masitis is no fun! Here’s what you can do to alleviate symptoms and get your chest back to feeling its best. 

• Rest! Consider yourself sick. The more you rest now, the sooner you’ll feel better.

• Frequent, gentle milk removal is still key, whether nursing, pumping, or expressing, but don’t overdo it.

• Nurse as often as your baby requests. It’s safe for them to have the milk.

• Take anti-inflammatory medications like ibuprofen.

• Use cold compresses on the affected side.

• Keep pumping and nursing equipment clean, but remember that it doesn’t need to be sterilized.

• If you get blisters or “milk blebs” on your nipples, don’t pick at them or apply topical cleaners or soaps. This will make the nipple dry out and potentially crack open.

• Ensure good latch and positioning. A lactation consultant can help with this.

• Discuss taking other medications or probiotics with your doctor.

• Check in on your mental health. Postpartum depression and anxiety can get worse when mastitis makes breastfeeding or chestfeeding a challenge. Reach out for support if you’re feeling anxious or down.

• Get in touch with a lactation consultant early on. They’re knowledgeable about all things lactation related, and serve as a valuable resource as you and baby get established. 

• Watch for red flags: worsening fever, spreading redness and warmth, or feeling very sick. Get medical care quickly if you experience these symptoms. 

Ongoing Mastitis Prevention

For some parents, mastitis is a recurrent problem. Keep it from coming back with these tips: 

• Avoid skipped feeds and stick to a nursing or pumping schedule. 

• Avoid overly tight bras, and vary the way you carry heavy bags if they have a strap that crosses your chest. If you wear baby in a sling, switch up the way you wear them to avoid putting constant pressure in the same spot.

• Vary nursing positions and ensure baby is latching properly. 

• Again, start working with a lactation specialist early on. They can help to treat and prevent nursing issues. 

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Final Thoughts

Mastitis is a real pain in the butt…or should we say boob? With the right information and support, you can beat inflammation and infection, and get back to feeling like yourself sooner. The updated approach to treating mastitis uses careful management to relieve pain and swelling, avoid unnecessary antibiotic use, and keep you on track for a positive nursing experience. Get help before you think you need it, so that you and baby can learn and grow together. We’re here to support you!