September 2, 2020

By Andrea Tran RN, BSN, MA, IBCLC

Anything that causes breast pain during breastfeeding is unsettling. While most women will not have to deal with the breast infection known as mastitis, if it happens to you this is what you need to know.

What is mastitis?

Mastitis is an infection of the breast tissue. Anyone can get mastitis, even if they are not breastfeeding including men and children. It occurs in about 20-30% of breastfeeding women. It occurs most frequently in the first 2-3 weeks of breastfeeding.

What are the symptoms of mastitis?

• A hard, painful lump in the breast that is reddened
• The hard area can be very large and may not feel like a defined lump but rather a hard section of the breast.
• Fever
• Flu-like symptoms

Some women will get the lump first while others will get the fever and flu-like symptoms first.

What causes mastitis?

The most common cause of mastitis is the bacteria staphylococcus aureus. It can also be caused by streptococcus bacteria.

Women who have nipple trauma are more likely to develop mastitis. Mothers with an oversupply of breast milk are also at higher risk of getting it. A clogged duct that does not resolve can turn into mastitis.

How is mastitis treated?

Mastitis is most commonly treated with antibiotics. The most common medications used are dicloxacillin and cephalexin. Recent research has been done on the effectiveness of probiotics for treating mastitis. While the results have been encouraging it is believed that more rigorous studies are needed.

How is mastitis different from clogged ducts and breast abscesses?

A clogged duct is a lump that results from milk backing up due to poor drainage. It may be tender and red but there is no fever or flu-like symptoms. Applying warm moist heat to the area before feeding or pumping and massaging the area during will usually resolve a clogged duct.

A breast abscess is an area of the breast that has a collection of pus. It can occur if mastitis is not treated. It requires surgery to drain the abscess.

Related: How to get rid of plugged milk ducts and prevent them from happening

Who should I call if I think I have mastitis?

Both your health care provider and a lactation consultant will be able to help you if you have a bout of mastitis. Your health care provider will make the diagnosis and can prescribe you antibiotics.

A lactation consultant can give you guidance in terms of managing feedings and pumping.

What will help me recover from mastitis?

Women describe feeling very sick from mastitis. It is important to rest and drink plenty of fluids. Ibuprofen can help with your symptoms.

You should start to feel better within 48 hours of starting the antibiotics. If you don’t feel improvement you should contact your health care provider. There is the possibility that you will need a different type of antibiotic.

It is important to take the full course of antibiotics or there is the risk that the infection won’t be completely cleared and can worsen.

Emptying your breasts regularly is essential to helping your body heal from mastitis. If breastfeeding is too painful then you should use a breast pump to empty your breast.

Moist, warm heat and massage of the affected area can be helpful for recovering from mastitis.

Is there anything I can do to prevent mastitis?

While most breastfeeding mothers will not get mastitis some unlucky women will get repeated cases of breast infections.

• Getting into the habit of making sure that all areas of the breast have drained well should help.
• If there is an area that still feels full after a feeding massage it during the next feeding to encourage good emptying.
• Avoid excessive pumping that can result in oversupply.
• Some mothers find that taking a lecithin supplement daily helps avoid repeat cases of clogged ducts and mastitis.

Sources

Angelopoulou, A., Field, D., Ryan, C.A. et al. The microbiology and treatment of human mastitis. Med Microbiol Immunol 207, 83–94 (2018). https://doi.org/10.1007/s00430-017-0532-z

Cullinane, M., Amir, L.H., Donath, S.M. et al. Determinants of mastitis in women in the CASTLE study: a cohort study. BMC Fam Pract 16, 181 (2015). https://doi.org/10.1186/s12875-015-0396-5

Barker, M., Adelson, P., Peters M. D. J., Steen, M. Probiotics and human lactational mastitis: A scoping review. Women and Birth 1871-5192 (2020). https://doi.org/10.1016/j.wombi.2020.01.001

Andrea Tran RN, BSN, MA, IBCLC is a freelance writer who has been helping moms and babies breastfeed for over twenty-five years. She is married and the mother of three adult children.