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Consumer Information Centre

 

Mastitis

Mastitis is an inflammation of the breast, resulting from an infection or a plugged milk duct.  A plugged milk duct will not drain properly but, if treated promptly, is less likely to progress to mastitis.  If pressure builds up behind the plugged duct, the surrounding area will become inflamed.

Effective milk removal is very important for mothers, and frequent and unrestricted breastfeeding helps to achieve this.  During a bout of mastitis frequent breastfeeding helps the treatment given and also prevents it from becoming worse.

A woman’s resistance to infection will be lowered if she is anaemic, run down or overly tired.  Breast infections sometimes occur in breastfeeding women when other members of the family have a cold or flu.

Signs of a plugged duct include:

  • a sore, hard lump in the breast
  • redness and soreness in the breast area
  • feeling ‘lumpy’ after feeding
  • achiness and a general feeling of being run down

The actual plug may never be seen by the mother, but occasionally she is able to express the plug (sometimes accompanied by mucus) through the duct opening on the nipple.  The plug will not harm the baby.

If the sore lump progresses to or is accompanied by a fever and/or flu-like symptoms this may indicate a breast infection.

Signs of a breast infection include:

  • a temperature above 38.4ºC
  • pus or blood in the mother’s breastmilk
  • red streaks on the breast
  • nausea or vomiting

The woman should visit her GP, who may suggest a course of antibiotics compatible with breastfeeding.

Causes of mastitis include:

  • abrupt weaning, returning to work or irregular feeding patterns, resulting in the breasts becoming full or engorged
  • shortened time of the baby at the breast, e.g. baby falling asleep before finishing a feed or having time at the breast limited
  • constricting clothing, or pressure on the breast (for example, from a heavy bag with shoulder straps) that restricts the flow of milk
  • poor attachment of the baby at the breast, resulting in only some parts of the breast being fully drained
  • cracked or damaged nipples, allowing entry for infection
  • stress, fatigue, or a compromised immune system

Treatment for a plugged duct / mastitis includes

  • frequent breastfeeding, every 2-3 hours (including night-time), draining the affected breast, and expressing between feeds
  • varying the position of the baby at the breast, so long as the baby achieves a good latch in all positions
  • lots of rest – in bed, if possible, with the baby
  • wet or dry heat applied to the affected area - e.g. hot water bottle, warm compress, a warm bath or shower
  • gently massaging the affected area in a circular motion while it is warm, then expressing breastmilk or feeding the baby to help unplug the duct
  • massage from the chest wall to the nipple over the sore area before and during feeding
    avoidance of constricting clothing, to prevent pressure on the milk ducts

Feeding during a bout of mastitis

It is important to continue breastfeeding, so as to avoid the possibility of developing a breast abscess, a serious condition.  Breastfeeding at this time will not be harmful to the baby, as breastmilk contains antibodies that protect him from infection.

Mastitis usually only affects one breast.  Feeding from the affected breast first is recommended.  Breastmilk from this breast may taste saltier, due to increased sodium and chloride levels, and it can help to try different feeding positions to encourage the baby to accept the breast. If a baby is still reluctant mothers can express milk from the affected breast, which maintains the milk supply until the salty taste is lost, usually within a week.

If the baby is less than two weeks old, and / or both breasts are affected, this could be a sign of hospital-acquired mastitis, which may be more severe.
A mother may find that a plugged duct or mastitis may result in a temporary reduction in milk production in the affected breast.  This should be resolved once the cause has been addressed, and can be helped by feeding longer or more frequently from that breast.

Recurring mastitis

Recurring mastitis is not uncommon, and can cause many mothers to give up breastfeeding.

Causes of recurring mastitis include:

  • stress and exhaustion
  • not recovering properly from the original mastitis / not taking the full course of antibiotics prescribed
  • too much saturated fat in the diet
  • too much sodium in the diet or, conversely, sodium deficiency
  • previous breast surgery or injury
  • overabundant milk supply
  • use of a nipple shield: whether this causes the blocked duct or the reason for the use of the nipple shield (damaged nipples, baby having a poor sucking technique) is to blame is unclear

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