Mastitis and the advice we now give
What is mastitis?
Mastitis is an inflammation of breast tissue that sometimes involves an infection.
The inflammation results in breast pain, swelling, warmth, and redness.
You may also experience chills and a fever.
Cause
The main cause thought to lead to mastitis is oversupply (hyperlactation), which leads to narrowing of the milk ducts and can then progress to inflammatory mastitis.
Mastitis during breastfeeding can make you feel run down, making it difficult to care for your baby. Sometimes mastitis can lead to a mother weaning before she intends to.
Continuing to breastfeed is better for you and your baby, even if antibiotics are required.
Old terminology
We used to use terms such as:
‘blocked ducts’
‘plugged ducts’
New terminology
We now use the terms:
‘localised breast inflammation’
‘inflamed breast tissue’
We now understand that lumps in the breast are most likely caused by inflammation, which leads to ductal narrowing, rather than an actual blockage.
Old treatment recommendations
Empty the breast by expressing or feeding more frequently
Release the blockage using deep tissue massage or vibration devices
Use heat to soften and release the blockage
Soak nipples in Epsom salts to remove blocked ducts
New treatment recommendations
Physiological breastfeeding by maintaining your normal supply, with no increase in feeding or expressing — just feed on demand
Handle the inflamed breast tissue gently, using only lymphatic massage (light sweeping of the skin)
Use gentle techniques to stimulate oxytocin for milk flow
Gentle stroking can be used
Apply cold compresses to reduce blood flow and swelling
Take NSAIDs such as Ibuprofen to reduce inflammation
What has not changed
Seek support from a lactation consultant to assess your positioning and attachment
Rest and maintain good hydration
If symptoms persist beyond 12–24 hours, seek medical review as antibiotics may be needed
If uncomfortable, you can hand express to relieve pressure
Remember to be gentle and avoid overstimulation.
Other new advice
Antibiotics were previously advised immediately for mastitis, sometimes as a precaution. However, new protocols suggest that antibiotics may not always be required — they are typically reserved for ‘bacterial mastitis’, rather than inflammatory mastitis or for prevention.
Some newer research supports the use of probiotics for mastitis prevention and nipple pain. There is also emerging evidence for using probiotics alongside antibiotics to help improve symptoms and reduce the duration of mastitis.
If using a probiotic with antibiotics, they should be taken at least 2 hours apart.
Therapeutic ultrasound
Some new studies suggest that therapeutic ultrasound may help reduce inflammation and oedema and can be an effective treatment when performed by an experienced physiotherapist.