Mastitis: What You Should Know

Nursing or pumping milk for your baby can be rewarding, but it can also come with some challenges. Mastitis, an inflammation of the breast tissue, is one of them. This common condition affects approximately 10 percent of breastfeeding people in the United States and comes along with unpleasant symptoms like pain and discomfort, engorgement and sometimes even fever and flu-like symptoms.

Knowing what causes mastitis and how to prevent it can reduce your chances of getting it, and learning the symptoms to look out for and how to treat them—both with medication and holistically—can help you get relief as soon as possible.

What is mastitis?

Mastitis is an inflammation of the breast tissue that can affect nursing people. It can be very painful and can cause symptoms such as fever, swelling, redness and overall discomfort. Mastitis can happen at any point during your nursing journey. Some breastfeeding parents get mastitis early on, while others get it midway through their time nursing or during the weaning process.

The understanding of what mastitis is has evolved within the scientific community, especially over the last few years. While it was once thought that mastitis was an infection, “it’s now thought that mastitis is more of an inflammation process,” almost like a spectrum of conditions, explains Vitalia Albertson, MSN, RN and IBCLC at the Cincinnati Breastfeeding Center and founder of @heyempoweredmama. “There’s definitely an infection component,” Alberston notes. “But it's all kind of started off by this inflammatory response in the body.”

What causes mastitis?

There are two primary causes of mastitis: an oversupply of milk, which can lead to the narrowing of milk ducts, and a bacterial infection.

1. Oversupply. The precursor to mastitis is usually not removing enough milk from the breast frequently enough, according to Alberston. “Either baby's not removing milk well enough, or we have a really big oversupply that's causing a lot of the clogged milk ducts,” she explains. And while the term “clogged milk duct” is commonly used to describe what’s going on when mastitis occurs, it’s a bit more nuanced than that. Milk is made and stored in lobules—groups of milk sacs. When those milk sacs become overfull, the ducts become compressed from the swelling around them, therefore slowing the flow of milk from the breast. This is called inflammatory mastitis.

2. Bacteria. Mastitis can also be caused by bacteria, usually following inflammatory mastitis or when bacteria enter the milk duct. Bacterial mastitis requires a different treatment than inflammatory mastitis. It’s not contagious and doesn’t pose any risks to your baby.

“Most nursing and pumping people get mastitis in the first few weeks when supply is the highest,” explains Albertson. It can also be brought on by a change in your regular feeding schedule. This can include:

• Being away from your baby for a long period of time and not expressing milk;

• When your baby starts to sleep for longer stretches overnight;

• When you’re traveling or during a holiday when you’re off your normal day-to-day schedule;

• When your baby isn’t eating as much as usual, such as if they’re sick.

What makes you more prone to mastitis?

Nursing people with oversupplies tend to be the most prone to getting mastitis, according to Albertson. This oversupply can be something that naturally occurs, but it can also be driven by pumping in addition to nursing. “It's not as common for a mom who is just breastfeeding and not doing any additional pumping to have a massive oversupply,” she explains.

There’s also a small subset of people who are more prone to mastitis for unknown reasons. “There's a thought that it has to be linked to like mom's microbiome, inflammation in her body and her gut health,” says Albertson. However, there is not yet very much good research on this, and this type of recurring mastitis tends to occur in a very small subset of people.

Mastitis symptoms

There are a host of different symptoms that can come along with mastitis, most of which involve discomfort and pain of some sort. These are the most common mastitis symptoms:

• A lump or tender spot in your breast (not always painful at the beginning, but eventually will be)

• Tender, swollen breasts or breasts that are warm to the touch

• Redness or streaking across the breast

• Breast pain

• Fever of 101℉ or greater

• Body aches and overall discomfort (many people describe the symptoms as flu-like)

Keep in mind there is a difference between engorgement—breasts with very full milk sacs—and mastitis. Your breasts can become engorged if you’ve skipped a feeding or a pump session, but that does not mean you have mastitis.

Early signs of mastitis

“What I normally see is mastitis is going to start as a clogged milk duct,” says Albertson. “From that, what I usually will see is that clog is going to start to get really painful, red, maybe inflamed, and then the telltale sign is going to be that fever. You can have mastitis without the fever, but I would say that's usually the thing that always tips people off that the clog has turned into more.”

There’s no timeline for how quickly—or how slowly—inflammation and mastitis symptoms can come on. “Everybody's body is a little bit different. Sometimes you might just wake up and feel like you got hit by the flu,” Albertson explains, while in other cases there may be more time between the start of the first symptoms and full-blown mastitis.

Mastitis treatment

You’ve noticed a painful spot in your breast or you’ve woken up feeling not so hot: now what? There are several ways you can treat mastitis, and many times the treatment options depend on your comfort levels, says Alberston.

Reach out to your OB or a lactation consultant

If you’re concerned you may have mastitis, reach out to your OB or a lactation consultant to discuss your symptoms and talk through treatment options. You can search for a board-certified lactation consultant through the International Lactation Consultant Association directory.

Mastitis antibiotics

Antibiotics are often prescribed as a treatment option for mastitis, and are required if you have bacterial mastitis. However, the Academy of Breastfeeding Medicine (ABM) mastitis protocols note that you don’t have to start antibiotics for the first 24 hours of symptoms. “You can try other therapies first, and if you’re not improving, then it is recommended to start antibiotics within 24 hours,” Albertson explains.

“A lot of times—and I think the new ABM protocols highlight this—is that what we're seeing is that mastitis is not necessarily an infection process. It's more an inflammatory process. And so antibiotics aren't always needed,” says Alberston. “It can sometimes, with proper treatment, be managed with more holistic ways.”

Mastitis self-care

Whether or not you’re prescribed antibiotics for mastitis, there are several things you can do at home to alleviate your symptoms and decrease inflammation. Here’s what Albertson recommends.

• Ice. Unlike the previous recommendation to apply heat to the inflamed area of your breast, the new ADM protocols recommend ice therapy. Use ice or cold compresses to reduce pain and inflammation.

• Anti-inflammatories and pain relievers. If it’s safe for you to take these medications, anti-inflammatories and pain-relieving medications such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) can help address the inflammation associated with mastitis and relieve your symptoms.

• Nurse baby on demand. If you’re wondering if you can breastfeed with mastitis, the answer is definitely yes. “If mom is direct breastfeeding or chestfeeding, that can be one of the most helpful ways to remove the buildup of milk in the ducts,” explains Alberston. She advises against feeding baby more frequently than normal, as that can have the reverse effect and actually increase breast inflammation during mastitis. If baby doesn’t want to eat, she recommends adding in a pump session.

• Gentle compression. You can use gentle compression—NOT deep massage or squeezing—during feeding to help treat mastitis. When you’re feeding or pumping, Albertson recommends using your hand to gently compress your breast. Avoid any deep massage or deep vibration; too much massage can actually increase inflammation and make mastitis worse. It can also make a clogged milk duct progress to mastitis. “Don’t treat a lump in your breast like a knot in your muscle,” she warns.

• Gentle massage. Also called lymphatic drainage, this gentle massage technique involves light pressure of your breast toward your lymph nodes above your collar bones and in your armpit. Think of it like petting a cat—light and gentle. This type of massage can help reduce swelling by moving fluid.

• Breast gymnastics. Developed by IBCLC Maya Bolman, breast gymnastics are a series of exercises that can help provide relief when your breasts are engorged or feel full or swollen.

• A supportive bra. A supportive bra can help with swelling and keep you more comfortable if you have mastitis.

• Rest. Don’t underestimate the power of rest. Remember that mastitis is based in inflammation, so resting and taking it easy can help you feel better sooner.

Here’s what not to do when you have mastitis:

• Deep, hard massage

• Vibration

• Excessive or continuous pumping or breastfeeding

• Apply heat

“Mastitis is a form of inflammation,” says Alberston. “And we really need to make sure that we're not making it worse. If we have an injury anywhere else in our body, we're going to ice, we're going to rest, we're going to take some anti inflammatories. We should be treating the breasts the same way.”

How to prevent mastitis

Mastitis is fairly common, and even if you’re doing all of the “right” things, it can still happen. But there are a few things to keep in mind while you’re nursing or pumping that can help prevent mastitis, according to Alberston.

• Be mindful of how long you’re going without milk removal. “I think that’s probably the biggest thing that catches people off guard—that they’ve gone too long without removing milk.” Sometimes, this can happen without you even realizing it, like if your baby starts sleeping longer stretches overnight or if you’re traveling for work or on a vacation. Try to anticipate this and address it as best you can. (Be especially aware of this if you’re prone to an oversupply, reminds Alberston.) Make changes slowly. It doesn’t mean you’ll need to wake up to pump forever, but it may mean you’ll need to do it for a little while as your body adjusts.

• Don’t do too much too soon. You may be tempted to try to jump back into your “normal” live and schedule during the postpartum period, but don’t, says Alberston. “I see this especially with new moms who are newly postpartum. If we're not removing the milk sufficiently enough, and then we are out of the house and we're on the go and doing a ton of different things, that can often spark mastitis to surface sooner than it naturally would,” she explains. Think of it along the lines of what you’d do if you started to feel like you’re getting sick: rest your body.

• Be sure your baby has a good latch. A good, deep latch means your baby can efficiently and effectively remove milk from your breasts. If you’re unsure if your baby is latching properly—or even if you just need a little reassurance along the way—reach out to a lactation consultant for help. If you’re insured, IBCLCs are often covered by insurance.

If you’re dealing with recurring mastitis, there may be an underlying issue going on from a feeding standpoint. Alberston recommends consulting with an IBCLC to address this.