Mastitis - La Leche League GB

Blocked milk ducts occur when milk is unable to flow through easily. You may notice your breast is warmer than usual, has a tender spot or a sore lump, and in some cases can appear redder. The redness can be harder to notice in darker skin tones. Mastitis (inflammation of the breast) happens when a blocked duct doesn’t clear and causes localised swelling and inflammation. It is also possible for the breast to become infected. If you have mastitis, you may feel ill with a fever or flu-like symptoms. If you have an infection as well, such symptoms will probably be worse. Treat any engorgement and blocked ducts promptly to avoid developing mastitis or even an infection, and be sure to address any possible causes.

Your commitment to breastfeeding your baby can be truly tested at times like this, especially when putting your baby to the breast may be the last thing you feel like doing. However continuing to breastfeed frequently is part of the solution and stopping suddenly is likely to make the problem a great deal worse.

Warning Signs … and action to take
Keep breastfeeding
Complementary therapies
Prevention is better than cure
To help avoid future problems
Breast infections
Cracked nipples
Keep the breast well-drained
Expressing blockages
Blebs and milk blisters
Breast abscess
Breast lumps
If mastitis recurs
Eliminating mastitis

Warning Signs … and action to take

If you

Feel a hard sore lump in your breast.
Feel that the skin on your breast is warmer to the touch.
Feel achy and run down.
Feel feverish with a temperature less than 38.4°C.
Notice your breast has areas that are redder than usual. This can be harder to notice in darker skin tones.

Take prompt action to improve milk flow…

Apply moist heat before feeds to promote milk flow. Between feeds apply a cold compress for up to 20 minutes at a time, to reduce swelling.
Breastfeed your baby at least 8–12 times each 24 hours (including night-time), especially from the affected breast. Encourage your baby to breastfeed enough to leave your breast feeling soft and comfortable. If he is unwilling, gently hand express or pump your milk. Your breasts should never become overfull.
Ensure your baby is well attached at the breast when he feeds. To make sure your baby drains the breast efficiently you may need to vary your nursing position but check your baby can latch on well in any new position. It helps if you can get your baby’s chin or nose pointing towards the blocked duct, even just for part of a feed. This may involve some nursing gymnastics on your part, like leaning over your baby and letting your breast hang loose! Visit our Comfortable Breastfeeding page for help with positioning and attachment.
Massage gently if it is not too painful to do so. Start over or behind the tender spot with your palm and fingers in a circular motion to help clear the blockage. Or massage in front of the lump. Start close to the nipple, and massage the short distance towards the nipple. Repeat, starting closer to the sore spot each time.
Consider taking a medication such as ibuprofen to help reduce the inflammation. Ibuprofen is compatible with breastfeeding, but check with your pharmacy about the safety of other anti-inflammatory painkillers.
Rest. Take your baby to bed and stay there together for as long as possible, since a blocked duct may be a sign that you are doing too much. If you have other children then ask for help and take it as easy as you can. See our tips on Safe Sleep & the Breastfed Baby.

If you:

Don’t feel better or see results in 8–24 hours.
Continue to feel feverish or your temperature suddenly increases to 38.4°C or more.
See pus or blood in your milk.
See red streaks on your breast from areola to underarm or your breast becomes redder than usual, hot, and swollen. This may be harder to notice in darker skin tones
Have a cracked nipple that looks infected.
Have chills and continue to feel worse.

Continue following the previous steps and also…

See your doctor as you may need antibiotics.
Take the full 10–14 days course of any prescribed medication.
Rest and drink plenty of fluids.
Ask an LLL Leader to help you find out what is causing the mastitis so that you can help prevent it recurring.

Address underlying causes to help prevent further bouts of blocked ducts and mastitis

Blocked ducts can be caused by any situation that affects milk flow in the breast including:

If your baby is not well-attached at your breast and is not breastfeeding effectively.
Missed, shortened or irregular feeds.
Giving bottles or over-using a dummy because this may affect your baby’s nursing pattern.
Anything which places pressure on the breast such as a bra that is too tight, other tight clothing, a car seat belt or bag strap, a baby carrier, or even lying on your front.

Keep breastfeeding

Source: United States Breastfeeding Committee

Antibodies in your milk will help protect your baby from any infection. Weaning from the affected breast is likely to make matters worse. When you feel at your worst from mastitis, the affected breast may produce less milk for a few days and your milk may taste slightly salty. Encouraging your baby to breastfeed frequently from the affected breast means that once the blockage has cleared your milk production will quickly increase to meet his needs.

Complementary therapies

Some mothers find these a helpful addition to the standard treatment for blocked ducts, mastitis and breast infections. Avoiding saturated fats and taking lecithin supplements can reduce the risk of blocked ducts. Take one or two 1200mg capsules three or four times a day.
Probiotic supplements can help reduce the risk of a thrush infection when taking antibiotics. Take from one to three capsules a day.

Prevention is better than cure

Mothers who experience a blocked duct or mastitis tend to find it occurs when they are doing too much or when they or the rest of the family are unwell with colds. Changes in routine, holidays, special occasions or family events, when you are busy or your baby is distracted and asks to feed less, can also increase the risk of blocked ducts. Some mothers are more susceptible than others to blocked ducts and mastitis. If you’ve had breast surgery or a breast injury or have a breast abnormality, these may increase the risk too.

To help avoid future problems

Breastfeed your baby frequently, avoiding long periods between feeds, day and night. Sleeping close to your baby can make night feeds easier.
Treat any engorgement promptly and check that all areas of your breasts feel soft and comfortable after feeds.
If any area of your breast is hard and uncomfortable, gently massage as you breastfeed.
Take extra care of yourself during holidays, special occasions and when family members are ill.

Breast infections

You are more likely to develop a breast infection if you stop feeding from a breast that already has a blocked duct or mastitis. A full course of antibiotics is needed to clear a breast infection—most antibiotics are compatible with breastfeeding. Stopping antibiotics early leaves you vulnerable to further infection.
Most, but not all, breast infections are caused by Staphylococcus aureus bacteria. Some strains of bacteria eg MRSA have become resistant to certain antibiotics. Let your doctor know if you have, or have had, MRSA, as this may help with prescribing appropriate treatment.
Repeated use of ineffective antibiotics increases the risk of a breast abscess. If a breast infection recurs, and especially if you took a full course of antibiotics, ask your doctor to arrange for cultures of your milk and your baby’s throat to determine an effective antibiotic treatment for you and/or your baby. If you need treatment for MRSA you can continue to breastfeed.
Sensible hygiene precautions include hand washing (including your baby’s hands), using disposable breast pads and thorough cleansing of pump parts and other items that are in contact with your nipples, eg nipple shields.

Cracked nipples

Sore, cracked nipples may increase the risk of a breast infection so take steps to improve positioning and attachment and nipple healing. Using a purified lanolin cream/product suitable for breastfeeding mothers can speed healing. Washing your nipples gently with mild soap and water may be helpful if a bacterial infection such as Staphylococcus aureus is involved. You could also ask your doctor about using a medicated ointment to promote wound healing.

Keep the breast well-drained

Studies have shown that a breast infection clears up more quickly when the breast is drained frequently. Antibodies in your milk help protect your baby from any bacteria that are causing the infection. You will be much more comfortable if you nurse your baby often rather than stop breastfeeding suddenly. Even temporary weaning is an unnecessary hardship when you aren’t feeling well.

Expressing blockages

Sometimes, when massaging a blocked duct, a mother expresses the coagulated milk responsible for the blockage. It may look like a crystal, a grain of sand, or even a strand of spaghetti, and it may be accompanied by a little particularly thick milk or mucus. If your baby clears the blockage when feeding, this will not harm him.

Blebs and milk blisters

Sometimes a mother gets white spots called blebs or milk blisters on her nipple. Thickened milk may block milk flow near the opening of the nipple, or a thin layer of skin may block the milk duct opening. Blebs can be associated with mastitis. A bleb that does not hurt may resolve on its own over several weeks. If it is painful:

Apply moist heat using warm compresses and then feed your baby—suckling may open the blister.
Soak the nipple in warm water.
Wear a cotton ball soaked in olive oil in your bra to soften the skin and then attempt to peel away the thickened layer of skin.

Then, compress the nipple behind the blockage to try and express the blockage. Sometimes it is possible to express a thickened string of milk, which helps open the duct and keep it open. Work back from the nipple to make sure there isn’t a blockage further back.
If this doesn’t bring quick relief, seek medical help to open the blister, perhaps from a nurse at your GP surgery. Opening the blister may allow milk to start to flow and bring relief but attempting to open it yourself could result in infection. If the bleb is dry you can use the approach suggested above to express the blockage. Once a blister is open, help prevent infection by washing the wound with mild, unperfumed soap and rinsing well once a day.

Breast abscess

A breast abscess is very unusual, but can occur if mastitis is not treated quickly. It is a very painful, localised infection containing pus. It can be diagnosed by ultrasound and needs immediate treatment by surgical drainage or aspiration of the breast. To avoid breast tissue being damaged unnecessarily, ask for the incision to be made:

As far from the nipple as possible.
And from nipple to chest, rather than around the breast.

The fluid should be cultured to identify the infection so you receive appropriate antibiotics. You can continue to breastfeed from both breasts. If the affected breast is too painful or the incision is close to your nipple you may need to hand-express for a day or two. Keeping your milk flowing will help your breast heal.

Breast lumps

Most women worry that they may have cancer when they discover a breast lump. Studies have shown that breastfeeding reduces a mother’s risk of breast cancer. However, a lump that does not go away after a week or recurs in the same place despite careful treatment for a blocked duct, needs checking. In many cases breast lumps are benign tumours (fibromas) or milk-filled cysts (galactoceles), which can be diagnosed and treated whilst you continue to breastfeed. It is very rare for a lump to be a sign of cancer. But do consult your doctor, especially if the lump continues to grow, does not move, or is firm and hard, and if there is dimpling of the skin.

If mastitis recurs

Mastitis often recurs if the original infection did not fully clear up, so consider whether you have addressed the original cause and taken medication as prescribed. Let your doctor know if treatment was not effective or improved things only slightly. If symptoms don’t improve or get worse, despite taking appropriate action, an LLL Leader may be able to explore the situation with you and share information on other possible causes of breast pain.

Eliminating mastitis

It may take a little time and persistence to deal with mastitis and enjoy comfortable feeds once more. Sometimes it takes time to find the right medication for an infection. Many mothers have found being creative about making time to rest and recuperate as well as using practical measures and complementary therapies alongside any medication can make a great deal of difference and help prevent blocked ducts and mastitis recurring.

Written by Karen Butler and mothers of LLLGB. Photos courtesy of Lois Rowlands.