Mastitis, which is a breast tissue infection, can occur at any time, even for women who have never been pregnant. It can happen at any point in your feeding journey, but most cases occur in the first two months. 

What causes mastitis?

Most cases of mastitis are caused by a unique combination of personal health factors. You may have heard about your microbiome, and this is a part of why some people are more prone to mastitis. Most mastitis starts as inflammation in one area of the breast. These areas of inflammation can progress to bacterial mastitis over time. Early treatment of inflammation can help reduce the risk of serious mastitis that requires antibiotics. We used to think that mastitis almost always came from bacteria entering the breast from nipple cracks or trauma. Now we know it’s much more complex, and there are other more important risk factors you can look out for. Read on to learn about what we know now:

Risk factors for mastitis:

• Previous cases of mastitis (during this phase of breastfeeding or with previous children)
• Engorgement from skipping or putting off feeds
• Oversupply
• Stress
• Anemia, which can lower the immune system and, thus, resistance to infections like mastitis
• Pressure on breasts from tight bras, seatbelts, or carrying a heavy bag
• Illness or infection in the mother or baby
• Use of antifungal creams
• Use of antibiotics 
• Cesarean birth

What does mastitis look like?

Mastitis usually only affects one breast, which may have color changes, and be swollen or painful. Mastitis is also often accompanied by fever, chills, and other flu-like symptoms, which may show up before visible symptoms like breast swelling or color changes do. New pain or a burning sensation during breastfeeding is also a symptom of mastitis. 

Parents who suspect they have mastitis in both breasts should not delay in contacting their healthcare provider or seeking more urgent care. It’s a rare situation to have mastitis in both breasts, and requires prompt evaluation and treatment.

How is mastitis treated? 

When mastitis symptoms are detected, it’s always a good idea to have them checked out by a provider. In many cases, early mastitis can be managed just with support for your symptoms and the inflammation. There is a point when antibiotics become beneficial, and your provider can help you decide if it’s indicated. If mastitis progresses and is left untreated, it can develop into a breast abscess, which often needs to be treated surgically.

If you’re prescribed antibiotics, these should start to relieve symptoms (especially flu-like symptoms) in the first 1-2 days. If you haven’t felt any improvement or are feeling much worse, it’s important to let your provider know. In this case, you may be asked to give a sample of your breastmilk to a lab to determine if you need a different antibiotic. While recovering from mastitis, acetaminophen and ibuprofen-based pain and fever relievers are both safe to use during breastfeeding. Ibuprofen is preferred, as it will help decrease inflammation too. It’s also important to get plenty of fluids and rest. Mastitis is a serious infection, and your body needs extra care. Using cold packs can reduce pain and pressure from inflammation in the infected breast. You can use cold for 5-10 minutes per hour, whenever it feels best for you. 

Can I breastfeed with mastitis? 

Breastfeeding with mastitis is safe for both you and baby, as are most antibiotics given for treatment. Many people experience some stomach upset from antibiotics for mastitis because they are generally given at a high dose. Probiotics can be beneficial for some people with stomach upset, and may help reduce your risk of getting mastitis again. 

Breastfeeding directly or pumping with mastitis can be uncomfortable, and it’s important not to overdo it. You don’t need to do any extra milk removal on the infected side, and in fact, this may make things worse. Choose a position or level of pumping suction that is most comfortable for you, and try to only feed or remove milk that your baby needs right now.

Support is here from your Ovia experts. Our lactation team can help you through this really challenging part of your feeding journey!

astitis, which is a breast tissue infection, can occur at any time, even for women who have never been pregnant. Most often, though, it shows up during early breastfeeding, usually within the first two months, before a nursing infant has fully settled into a regular feeding pattern with a healthy latch.

What causes mastitis?

Most cases of mastitis are caused by bacteria entering the body through the nipple – often through nipples that are cracked or sore from breastfeeding. Working to make sure to only handle dry or cracked nipples with hands that have been washed with hot water and soap can help cut down on infections this way. The other reason a breast might become infected would be due to a blocked milk duct, which can happen when breasts aren’t fully emptied during or after a feeding.

Several factors lead to an increased risk of mastitis, including:

• Previous cases of mastitis
• Engorgement from skipping or putting off breastfeeding or pumping, especially if this happens often
• Cracked or irritated nipples, especially irritation caused by trouble with latching
• Anemia, which can lower the immune system and, thus, resistance to infections like mastitis
• Only breastfeeding in one position, which can lead to breasts not being fully emptied
• Pressure on breasts from tight bras, seatbelts, or carrying a heavy bag
• Illness or infection in the mother or baby

What does mastitis look like?

Mastitis usually only affects one breast, which may be red, swollen, or painful. Mastitis is also often accompanied by fever, chills, and other flu-like symptoms, which may show up before visible symptoms like breast swelling or redness do. Pain or a burning sensation during breastfeeding is also a symptom of mastitis. Early signs include slight swelling or redness of the breast.

How is mastitis treated?

When mastitis symptoms are detected, it’s always a good idea to have them checked out by a doctor, since, when left untreated, mastitis can develop into a breast abscess, which often needs to be treated surgically. Caught early, though, a doctor will generally make a diagnosis based on an exam, and prescribe antibiotics, which should begin to relieve symptoms in the first two days or so. It’s important to keep taking antibiotics for the full 10 to 14 day course, even if the symptoms seem better, to cut down on the chances of the mastitis returning. If the antibiotics prescribed don’t start to have an effect in a few days, the doctor may recommend testing to find out what kind of infection is causing the mastitis.

While recovering from mastitis, acetaminophen and ibuprofen-based pain relievers are both safe to use during breastfeeding. It’s also important to get plenty of fluids and rest. Using cold packs can also reduce pain and pressure from inflammation in the infected breast. Before breastfeeding, it can help to massage the breast, and to use a heat pack or a warm, wet washcloth to help with milk-flow.

Can I nurse with mastitis?

Breastfeeding with mastitis is not only safe for both you and baby, but it can actually help clear up the infection as it increases blood-flow and the flow of milk through the breast, helping to clear out blocked ducts. However, some babies won’t nurse at a breast that’s infected with mastitis, and in those cases, hand-expressing or using a breast pump works just as well.

Sources

• Mitchell KB et al. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022.  Volume 17. “Mary Ann Liebert, Inc., Publishers”. 2022. Print.
• Deng Y, Huang Y, Ning P, Ma SG, He PY, Wang Y. “Maternal Risk Factors for Lactation Mastitis: A Meta-analysis”. West J Nurs Res. 43(7):698-708. Web. July 2021.