Managing Mastitis

A painful, extremely common issue for mums in the postpartum period, we treat Mastitis like a medical emergency because we know that if left untreated—things can escalate quickly. 

This page will assist in identifying symptoms, provide you with at home relief and support should you think you have Mastitis.

What is Mastitis?

Mastitis encompasses a spectrum of conditions of the lactating breast. Mastitis often starts as milk duct narrowing and congestion aka “plugging of the milk duct”, which can quickly progress to inflammatory type mastitis. If left untreated, inflammatory mastitis can progress to acute bacterial mastitis, or the development of an abscess.

Multiple factors contribute to the development and progression of mastitis, including milk oversupply (hyperlactation), nipple trauma, disruption of the milk microbiome, overfeeding and overstimulation (especially from the regular use of breast pumps), and Cesarean births. Mastitis isn’t always preventable but can be treated if you catch the symptoms and warning signs early.

Step 1: Recognising the Symptoms

The symptoms of Mastitis can come on very suddenly and knowing what to look for is key to catching Mastitis early.

Symptoms include but are not limited to:

• Breast congestion, swelling, and tenderness to the touch

• Redness, blushing, or shiny red streaks throughout the breast tissue; may also be warm to the touch

• Shiny or red streaks on skin of breast tissue

• Whole body symptoms, such as shivers and body aches, similar to signs and symptoms of the flu

• Discomfort or nipple discharge

• Breast swelling

If a firm and sore lump appears in your breast but you otherwise feel well, you probably have early signs of mastitis, and may manage well at home with the home-care strategies outlined below.

If you have an inflamed, sore, swollen, or red breast you may have progressed to inflammatory Mastitis. At this point, it’s important not to hesitate seeking treatment from us or another qualified practitioner. You must act quickly to avoid progression to bacterial mastitis or abscess formation

We treat mastitis as a medical emergency, please contact the clinic to arrange a same-day appointment. Should this happen from 1pm Saturdays, Sundays or a public holiday, please contact our after-hours mastitis service and our team will be in contact within 8 hours.

Step 2: Start With the Basics

Get some advice early
If you have a postnatal physiotherapist already on board, then seeking prompt and effective treatment at the first signs of mastitis will help halt your progression through the spectrum; as early identification of the stage of mastitis pathology is crucial in providing the appropriate advice for treatment.

Continue breastfeeding
Mastitis is not contagious, or a contraindication to stop breastfeeding.

Focus on Physiological breastfeeding
Feed your baby on demand, and do not aim to empty the breasts more than what baby consumes.

Mothers using breast pumps should express milk at a frequency and volume that mimics baby’s physiological needs, only expressing the volume their bub consumes.

But what if I can’t get any milk out?
In some cases, the breast may be so swollen and inflamed little to no milk is expressible. In this case, it may be appropriate to reduce feeds from the affected breast until you have reduced the inflammation (Don’t worry, we’ll help you do this!)

Reduce Inflammation
Ice application, lymphatic drainage massage, and nonsteriodal anti-inflammatory drugs (NSAIDs) can be beneficial in reducing swelling, inflammation, and provide symptomatic relief.

• Apply Ice
  Ice can be applied topically to the area of affected breast tissue every hour or more frequently if desired in between feeds.

• Perform Lymphatic drainage massage
  Using cupping and sweeping strokes, perform light massage over the breast towards the armpit for a minimum of 5 minutes immediately post-feed. We recommend performing this in the shower, or with the assistance of a food-grade olive oil (please keep infant allergies in mind when choosing a product). Please see our video below for a quick how to.

• Utilise Therapeutic Ultrasound (ThUS)
  ThUS uses thermal energy to reduce inflammation and relieve swelling. Come and visit us in the clinic to have one of our physiotherapists apply your therapeutic ultrasound, or look for a qualified therapist near you who can help.

A little extra support
Wear an appropriately fitting bra, that is comfortably compressive - Lactating breasts require support.

Decrease stress & Increase opportunities to rest
Try to get some extra rest, can you sneak a sleep in? Drink adequate H20 throughout the day, aiming for up to eight glasses, and ask for help with household chores and responsibilities. Breastfeeding alone is the equivalent hours to a full-time job.

Reserve antibiotics for bacterial mastitis
Let us reassure you that many mastitis symptoms will resolve with conservative care, and you can often achieve complete resolution of symptoms without need for antibiotics.

The use of antibiotics for inflammatory mastitis disrupts the breast microbiome and increases the risk of progression to bacterial mastitis. (It’s important to note many antibiotics have anti-inflammatory properties, and this may explain why women have experienced relief when taking these in the past).

Explore supplementation with Sunflower or Soy lecithin
Evidence suggests it may reduce the inflammation in milk ducts and emulsify milk if it’s appropriate for you. We’d recommend discussing this with your medical provider first.

Do not to do the following:

Repeatedly Feed
Don’t repeatedly feed in an attempt to relieve the “plug”, this can result in increased milk production, and ultimately exacerbate inflammation and ductal narrowing.

Aggressively Massage
Avoid deep, firm, and aggressive massage of the breast, as they may result in tissue trauma and increased inflammation. This means, avoiding electric toothbrushes and other commercial vibrating devices too.

Apply Heat
Heat will vasodilate and worsen symptoms in the long-term, although it may provide short-term comfort.

Rush out to buy probiotics
Data on their efficacy is slim, but promising in suggest probiotics may be effective for both treatment and prevention of mastitis. While it may be something you explore and discuss with your medical provider, it is not suggested as your first line of treatment!

Lymphatic Drainage Massage

Below is a video to explain best practice for self massage at home.

Please ensure you get in touch and contact the clinic immediately should pain and discomfort escalate as per advice above & we will arrange a same-day appointment.

Business Hours: 0401 569 209
Weekends + Public Holidays: 0458 961 795
(Saturdays from 1pm, we will be in touch within 8 hours)

Also note that the information on this page is not intended as a substitute for professional consultation with a qualified practitioner.

If you require urgent care - go to the nearest Emergency Department.

The above information is guided by the Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022.