Mastitis 101: The Symptoms and the Cure

Medical Experts: Alan Lindemann, MD; Molly Petersen, CLC; Laura Purdy, MD, MBA

There’s no question that breastfeeding can be a beautiful bonding experience, but it doesn’t always come easy. Your infant might have trouble latching, you might have issues with your letdown reflex, or you could suffer from cracked nipples. Another potential hurdle? Mastitis, a condition that can cause flu-like symptoms and serious breast pain. Here’s what you need to know about this common ailment which affects up to 20% of breastfeeding women.

Mastitis typically happens early in the fourth trimester, about six to eight weeks postpartum, but it can occur at any point while breastfeeding. Often, the pain and discomfort from mastitis are why most new moms wean early on, so it is important to get treated as soon as possible in order to continue breastfeeding.

What Are the Symptoms of Mastitis?

Mastitis, or inflammation of the breast, can come on very suddenly, causing severe burning pain during breastfeeding. Alan Lindemann, MD, an OB-GYN practicing in North Dakota, describes some of the common (unpleasant) symptoms of mastitis, saying, “The breast is red, hot, firm, and sore in an area of about 2 inches in diameter.”

Don’t be surprised if you feel fluish, too.

“You may feel tired and lethargic, have muscle aches, nausea, and/or a fever,” Molly Petersen, a certified lactation consultant with Lansinoh tells Pregnancy & Newborn. “If you have any of these symptoms, reach out to your doctor or health care provider.”

What Are the Causes of Mastitis?

When you’re breastfeeding with sore, cracked, bleeding nipples, you run the risk of developing a breast infection, which is one form of mastitis. “The infection is usually due to bacteria from the skin, either staph or strep,” says Laura Purdy, MD, chief medical officer at OpenLoop. Once the bacteria finds its way inside the body, it causes a painful infection in the breast tissue.

Mastitis isn’t always the result of a bacterial infection, though. “It is common for mastitis to only be inflammatory in nature and not have a bacterial or infectious component,” Dr. Purdy says. In this case, she says “it is typically due to milk remaining in the ducts or lobules so long that it becomes stagnant and [the ducts become] inflamed.”

Another common culprit? A small lump in the breast, also known as a clogged or blocked milk duct, that may be irritated or painful to the touch. According to the American Academy of Pediatrics (AAP), clogged milk ducts can occur for a variety of reasons including a sudden change in your baby’s feeding schedule, wearing too-tight tops or bras, inadequate draining of the breast, and failing to switch up nursing positions. Many lactating women will experience a clogged (or plugged) milk duct at some point while breastfeeding, but if you catch them and treat them early, they don’t always lead to mastitis.

How Can You Prevent Mastitis?

Since this condition can stem from either bacteria or inflammation, you’ll have to keep things both clean and functioning smoothly to stay on track.

“The best way to prevent mastitis is frequent emptying of the breast,” says Dr. Purdy. “Especially in the first 90 days of lactation, when there can be problems with oversupply, it is very important to make sure that the breast is frequently getting emptied and that milk is not allowed to be stagnant.”

On the bacterial front, you can help reduce your chances of getting mastitis by following good breastfeeding guidelines, says Petersen.

“Try to avoid bras or clothing that is too tight or that holds moisture, change your nursing pads frequently, and allow baby to nurse on one side until the breast feels empty before switching sides,” she says.

Does Mastitis Interfere With Breastfeeding?

“It is considered safe to continue to nurse your baby on both breasts [when you have mastitis],” says Dr. Lindemann. In fact, according to Petersen, continuing to breastfeed and pump is actually “crucial” to both ease symptoms and keep the infection from progressing.

“Getting engorged and having your breasts become swollen with milk will make you feel worse,” she says, “and could cause the infection to stick around longer.”

Additionally, even if you notice a drop in breast milk supply on the affected breast (which sometimes occurs when your symptoms are the worst), you should still feed baby from that side to ensure it is emptied. If your little one has trouble emptying your breast, use hand expression or a pump to thoroughly drain excess milk.

What’s the Best Way To Treat Mastitis?

“Mastitis that is purely inflammatory in nature and does not involve a bacterial infection can often be resolved with simple measures,” says Dr. Purdy. She suggests using warm compresses on the affected area, taking anti-inflammatories (such as ibuprofen), and regularly expressing milk to empty the breast to avoid blockage and engorgement.

Sometimes, she adds, a mastitis infection will be substantial enough to require antibiotic treatment (usually dicloxacillin or something similar). “There are several antibiotics available that are perfectly safe to use while breastfeeding and do not cause any harm to the baby or the milk supply,” she notes.

Another possible remedy? A massage. According to Petersen, giving your breasts a gentle massage while feeding can help stimulate milk flow. “You’ll also want to loosen any tight clothing or bras, and you can try adding in a hot shower to help you feel more comfortable,” she adds.

Are There Any Potential Complications With Mastitis?

Unfortunately, the answer is yes. And they don’t sound like fun.

“Perhaps the absolute worst case scenario, which is very rare, would be sepsis and a bloodstream infection,” says Dr. Purdy. She explains that sepsis occurs when a bacterial infection causes symptoms that spread far beyond the area that is actually infected, often causing fever and widespread inflammation. Fortunately, “it is very rare that mastitis causes sepsis because it is usually caught and treated quickly,” Dr. Purdy says.

“A more common complication of mastitis is a breast abscess,” she adds. “An abscess is a pocket of pus or fluid that does not improve with oral antibiotics or milk expression. An abscess, or a collection of pus, needs to be cut open and drained in order for it to heal.”

Suffice it to say, if you are in any way concerned that your mastitis has progressed into sepsis or that you’ve developed an abscess, call your health care provider right away.

Does Mastitis Ever Go Away on Its Own?

“Sometimes,” says Dr. Purdy. “Especially if the woman can catch it early and initiate frequent emptying of that breast, it’s very possible that mastitis may resolve on its own.” It might take a little time; the breast will need a few days to heal after the pain subsides. But according to Dr. Purdy, as long as the redness is going away, the fever is fading, and the pain is getting better, then “good progress is being made.”

Mastitis is unfortunately a common pitfall for breastfeeding parents, but if you catch it early enough, it doesn’t need to become a super painful issue. Just pay attention to your body and make sure you’re fully emptying your breasts, so you don’t have to worry about clogs. Also, keep cracked nipples clean and bacteria-free, and remember to stay away from tight bras.