Mastitis

What is mastitis?

Mastitis is painful inflammation in your breast tissue that can lead to a bacterial infection.

Anyone can get mastitis. It’s most common in women and people assigned female at birth (AFAB) who breastfeed (chest feed). Men and people assigned male at birth (AMAB) and people who don’t breastfeed can also get it, but this is rare.

How common is mastitis?

Mastitis affects up to 10% of breastfeeding people in the United States. It may affect up to 30% of breastfeeding people worldwide. It’s most common in the first three months of breastfeeding.

What are the symptoms of mastitis?

Mastitis is inflammation. This means your breasts may be swollen, tender or warm to touch. Your breasts may become engorged. You may also experience:

• Breast pain (mastalgia) or burning sensation that worsens when your baby nurses.
• Hard lumps on your breast.
• Red marks on your breast.
• Flu-like symptoms, including fever and chills if mastitis infection occurs.

Engorgement is most common in the first few days after you give birth, but can occur as long as you produce breast milk.

What causes mastitis?

The most common cause of mastitis is hyperlactation or an oversupply of milk. This oversupply of milk causes your milk ducts to narrow because the surrounding tissue puts pressure on the ducts. This leads to engorgement, which is when your breasts are extremely full and swollen. This is known as inflammatory mastitis.

Inflammatory mastitis can lead to bacterial mastitis. Bacteria mastitis is when infection occurs due to inflammatory mastitis.

Sometimes, a bacterial infection leads to an abscess. An abscess is a collection of fluid that requires draining.

Risk factors for mastitis

You’re at higher risk for getting mastitis if you breastfeed and have an oversupply of milk.

In recent years, healthcare providers have changed their recommendation for dealing with oversupply. The previous recommendation suggested emptying your breasts more often would treat the symptoms of oversupply.

However, current research shows that this actually makes engorgement worse. Emptying your breast more than usual (pumping or feeding) will only lead to more milk production and further aggravate the inflammation.

How is mastitis diagnosed?

Your healthcare provider will do a physical exam and check your symptoms to make a diagnosis. If you aren’t breastfeeding, you may get a mammogram or breast ultrasound to rule out breast cancer or a different breast condition.

What is the best treatment for mastitis?

Treatment for mastitis involves reducing inflammation and pain and preventing an infection from occurring. Researchers are always learning more about lactation and mastitis, so it’s important to talk to your healthcare provider to make sure you’re getting current treatment information.

Previous treatment methods for mastitis involved heat, massage and extra pumping or feeding. Now, many providers say you should treat inflammatory mastitis like a sprained ankle. You wouldn’t massage an ankle sprain or put a heating pad on it. Mastitis should be treated similarly. The swelling in your breasts is mostly due to swelling of the structures around the milk — it’s not a “plug of milk” needing “worked out.” Rather, the inflammation needs to be decreased in order for the milk to flow better.

At-home treatment for inflammatory mastitis includes:

• Ice: Use an ice pack or a frozen bag of vegetables to reduce swelling while laying on your back so the swelling drains into your lymph nodes. You shouldn’t apply heat.
• Pain relievers: Using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or naproxen can reduce swelling and pain.
• Lymphatic drainage: Lymphatic drainage involves gentle, light “petting of a cat” pressure of your breast toward your lymph nodes above your collar bones and in your armpit. It reduces swelling by moving fluid. This isn’t as strong of pressure as a massage.
• Reverse pressure softening (RPS): This type of massage reduces swelling in your areola and nipple by moving the fluid away from it. It allows your baby to latch more easily to a full breast. To perform RPS, place two fingertips around the base of your nipple. Apply pressure, then drag your fingers away from your nipple. Do this at several angles around your nipple.
• Wear a supportive bra: A supportive bra isn’t tight-fitting and doesn’t put more pressure on your breasts.

DO NOT:

• Aggressively massage your breast.
• Use any type of massaging device on your breast.
• Soak your breast in anything.
• Apply heat.

Medications for bacterial mastitis

If at-home treatment for inflammatory mastitis doesn’t help, it could progress to bacterial mastitis. Your healthcare provider will prescribe an antibiotic to treat a bacterial mastitis infection. They work to eliminate the bacterial infection that’s built up in your milk ducts. The infection should clear up within 10 days. However, you should begin to feel relief within 48 to 72 hours. Over-the-counter medications like acetaminophen and ibuprofen can help with pain and inflammation, but they can’t treat an infection.

What are the complications of mastitis?

If left untreated, a breast infection like mastitis can lead to a breast abscess. This type of abscess typically requires surgical treatment. Your healthcare provider will perform minor surgery or use a small needle to drain the pus.

How long does mastitis last?

Inflammatory mastitis usually gets completely better within 10 to 14 days. When managed correctly, symptoms improve dramatically within 24 to 72 hours. Recognizing the signs of engorgement and inflammation is key, because then you can start to implement treatment methods like ice and lymphatic drainage.

Is it safe to continue breastfeeding when you have mastitis?

Yes, you should continue to nurse your baby. You can’t pass a breast infection to your baby through breast milk. In fact, breast milk has antibacterial properties that help babies fight infections. Antibiotics that your provider prescribes for mastitis are usually safe for your baby.

It may be uncomfortable to nurse when you have mastitis, but you should continue to do so.

Can I get mastitis more than once?

Yes, it’s possible to get mastitis multiple times.

How can I prevent mastitis?

A good rule of thumb is to only pump what’s needed for your baby. If you’re feeding from your breast, don’t pump afterward to “drain” it.

It might be helpful to talk to a lactation consultant or attend a breastfeeding class to learn what a good latch looks like and feels like. A latch is how your baby nurses from your breasts. A good latch may help with mastitis because your body can naturally adjust your milk production to your baby’s milk intake.

People who are breastfeeding can also take these steps to lower their chances of getting mastitis:

• Don’t wear tight-fitting bras.
• Avoid using nipple shells or other devices on your breasts.

What can I expect if I have mastitis?

Mastitis is painful and uncomfortable, but it usually doesn’t cause long-term problems. At-home treatment using the methods above usually lead to positive outcomes.

If you’re nursing, you may make less milk as your body fights off the bacterial infection. Milk production should increase as you start to feel better.

Does mastitis increase your risk of breast cancer?

Mastitis doesn’t increase your risk of breast cancer. However, mastitis symptoms are similar to inflammatory breast cancer symptoms. This rare type of breast cancer causes breast skin changes. Signs may include dimples and a breast rash that has an orange-peel texture. Like mastitis, one or both breasts may become red and swollen. Inflammatory breast cancer doesn’t usually cause breast lumps.

Inflammatory breast cancer is an aggressive cancer. It requires prompt diagnosis and treatment. Contact your healthcare provider right away any time you notice breast changes.

When should I see my healthcare provider?

You should call your healthcare provider at-home treatment for engorgement doesn’t help. Other symptoms that may warrant a call to your provider include:

• Breast pain.
• Changes in the way your breasts feel.
• Newly discovered lump.
• Nipple discharge.
• Worsening of symptoms after 24 hours of antibiotics or several days of at-home treatment.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• Why did I get mastitis?
• How long until it goes away?
• What is the best treatment for me?
• What steps can I take to prevent getting mastitis again?
• Should I look out for signs of complications?

Should I go to the ER for mastitis?

It’s rare to need to go to an ER for mastitis. If your symptoms are worsening and you’re concerned about having to wait to see your healthcare provider, going to your nearest emergency room may give you peace of mind. Those already on antibiotics having worsening fevers and swelling may need imaging to rule out an abscess.

How do I know I have mastitis and not a clogged milk duct?

“Clogged” or “plugged” ducts are areas of inflammation or engorgement surrounding the ducts that compress the milk ducts, making it harder for the milk to come out or flow. When the inflammation isn’t treated properly, it can lead to mastitis.

A note from Cleveland Clinic

Any type of breast change is a reason to call your healthcare provider. While mastitis isn’t cancerous, your healthcare provider should evaluate your symptoms. Rarely, breast infection symptoms are a sign of inflammatory breast cancer. If you develop mastitis while you’re breastfeeding, it may be helpful to talk to a lactation consultant. They can ensure proper latching and breastfeeding techniques so you don’t develop mastitis again.