Mastitis While Breast-Feeding

What is mastitis?

Mastitis is a breast inflammation usually caused by infection. It can happen to any woman, although mastitis is most common during the first 6 months of breast-feeding. It can leave a new mother feeling very tired and run-down. Add the illness to the demands of taking care of a newborn, and many women quit breast-feeding altogether. But you can continue to nurse your baby. In fact, breast-feeding usually helps.

Although mastitis can be discouraging and painful, it is usually easily cleared up with medicine.

What causes mastitis?

Mastitis most often happens because the breast gets too full. Usually this is because you have missed a feeding or have not completely emptied the breast. When milk builds up, it can leak into breast tissue. The tissue can become swollen and easily infected.¹

Infection can also happen when nipples become cracked or irritated. Make sure your baby is latched on and positioned correctly to avoid sore nipples. When nipples are cracked, bacteria can get into the breast.

Learn about the different ways to breast-feed so that you know how to completely empty your breasts and avoid cracked nipples.

What are the symptoms?

Mastitis usually starts as a painful area in one breast. It may be red or warm to the touch, or both. You may also have fever, chills, and body aches. If you have these symptoms, call your doctor today.

Signs that mastitis is getting worse include swollen, painful lymph nodes in the armpit next to the infected breast, a fast heart rate, and flu-like symptoms that get worse. Mastitis can lead to a breast abscess, which feels like a hard, painful lump.

What increases my risk of developing mastitis?

You are more likely to get mastitis while breast-feeding if:

• You have had mastitis before.¹
• You delay or skip breast-feeding or pumping sessions. When you don't empty the breast regularly or completely, your breasts become engorged or too full, which can lead to mastitis.
• You have cracked or irritated nipples, which can be caused by poor positioning or latch-on to the breast.
• You have anemia. Anemia makes you tire more easily and lowers your resistance to infections like mastitis.
• You use nipple shields or shells, breast pads, or other breast-feeding aids. These can block milk flow and increase germs on the nipple surface, increasing the chance of infection.
• Your nursing bra is too tight.
• You wear breast binders, which are used to suppress milk production.

Breast-feeding mothers can get mastitis at any time, but especially during the baby’s first 2 months. After 2 months, the baby’s feeding patterns become more regular, which helps prevent mastitis.

How is mastitis diagnosed?

Your doctor can tell whether you have mastitis by talking with you about your symptoms and examining you. Testing is usually not needed. However, mastitis will not go away on its own, so you should see a doctor for treatment.

How is it treated?

Antibiotics can usually cure mastitis. If your doctor prescribes antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of pills. The antibiotics will not harm the baby. If treatment doesn't work at first, your doctor may send a sample of your breast milk to a lab to help identify the type of bacteria causing the infection.

You can help yourself feel better by getting more rest, drinking more fluids, and using cold packs on your painful breast.

Before breast-feeding your baby, place a warm, wet washcloth over the affected breast for about 15 minutes. Try this at least 3 times a day. This increases milk flow in the breast. Massaging the affected breast may also increase milk flow.

You can safely take acetaminophen (such as Tylenol) for pain. You can take ibuprofen (such as Advil) along with acetaminophen to reduce inflammation.

Breast-feeding from your affected breast is safe for your baby and helps to treat your mastitis.¹ If starting with the affected breast is too painful, start feeding on the other side, then switch sides after your milk lets down and starts flowing easily. If your nipples are too cracked and painful to breast-feed from that breast, use a breast pump to empty the breast of milk. Use it each time that you cannot breast-feed.

This is a good time to consider getting help from a lactation consultant. This person—usually a nurse—specializes in helping women with breast-feeding. You can breast-feed more effectively with less pain and help prevent future mastitis if you remember to change positions and make sure that your baby is latching on properly.

It’s important to get treatment for mastitis. Delaying treatment can lead to a breast abscess, which can be harder to treat.

Frequently Asked Questions

The symptoms of mastitis most often appear within 4 to 6 weeks after childbirth. Call your health professional today if you develop any of the early symptoms of mastitis.

If you have mastitis , you may first notice:

• A painful area on one breast. It may be reddened, warm to the touch, or both.
• Chills, aches, and flu-like symptoms.
• A temperature of 100° (37.8°) or higher.

These initial symptoms may start after you have resolved a blocked milk duct.

Worsening symptoms

As a mastitis infection worsens, you may notice:

• An increased heart rate (more than 100 beats per minute).
• Thick, yellow drainage (pus) coming from the nipple.
• Swollen and tender lymph nodes in your armpit on the same side as the infected breast.

Breast abscess

Occasionally symptoms of mastitis worsen and the breast develops a pocket of pus (abscess) in the infected area. Symptoms of a breast abscess include:

• A breast lump that is hard and painful.
• A reddened area on the breast.
• Worsening of flu-like symptoms.

Thrush infection

Thrush (yeast infection) can occur in your baby's mouth and spread to your nipples, as well as deep in the breast ducts. If you have symptoms of mastitis that are not going away in spite of treatment, pain in the nipple area during and after breast-feeding, sharp breast pain in between feedings, or nipples that look very pink, you may have thrush. This condition can also begin as a sudden onset of pain or burning when breast-feeding has been going well without problems.

If you have thrush symptoms, both your nipples and your baby's mouth should then be checked for thrush. Treatment for thrush requires that both you and your baby be treated, even if your baby doesn't have symptoms. For more information, see the topic Thrush.

Your health professional can usually diagnose mastitis based on your symptoms and an examination of the affected breast . Tests are usually not needed. However, they may be done to confirm a diagnosis or to help guide treatment for other problems that can develop.

Breast milk culture

If you have an infection that isn't improving with treatment, your health professional may do a breast milk culture. To provide a sample for a culture, you will squeeze a small sample of milk from the affected breast onto a sterile swab. The culture results help your doctor confirm a diagnosis and to find out the specific bacteria that are causing the infection.

Occasionally it takes more than one round of antibiotics to clear a breast infection. If you have not been responding to antibiotic treatment, culture results may be used to determine the most effective antibiotic for you.

Abscess

Sometimes a pocket of pus (abscess) forms in the reddened area of the breast. If an abscess is too deep to examine by touching it, your health professional may use a breast ultrasound to examine it. Ultrasound can also be used to guide a needle to an abscess that needs to be drained of fluid. A culture of the abscess fluid is usually done to identify the infecting organism.

Mastitis will not go away without treatment. If you develop mastitis symptoms, call your health professional today. Prompt treatment helps keep infection from rapidly worsening and usually improves symptoms after about 2 days.

Mastitis treatment

Treatment for mastitis usually includes:

• Oral antibiotics to destroy the bacteria causing the infection.
• Regularly emptying the breast well by breast-feeding or pumping breast milk. Adequate emptying of the affected breast helps prevent more bacteria from collecting in the breast and may shorten the duration of the infection.

You can safely continue breast-feeding your baby or pumping breast milk to feed your baby during illness and treatment.¹ Your baby is the most efficient pump you have for emptying your breasts. Your breast milk is safe for your baby to drink because any bacteria in your milk will be destroyed by the baby's digestive juices.

• Before breast-feeding your baby, place a warm, wet washcloth over the affected breast for about 15 minutes. Try this at least 3 times a day. This increases milk flow in the breast. Massaging the affected breast may also increase milk flow.
• If possible, continue breast-feeding on both sides. Ideally, start on the affected side; it's critical that you empty this breast thoroughly. If this breast is too painful to start with, try feeding from the healthy breast first. Then, after your milk is flowing, breast-feed from the affected breast until it feels soft. Switch back to the healthy breast and breast-feed until your baby has finished.
• Pump or express milk from the affected breast if pain prevents you from breast-feeding. Nipple pain can be caused by the baby latching on to sore nipples. For more information on pumping or expressing breast milk, see the topic Breast-Feeding.

Breast abscess treatment

If you have mastitis because of a blocked duct and you delay treatment, your breast infection may develop into an abscess. Treatment for an abscess includes:

• Draining the abscess. Abscess healing can take 5 to 7 days.
• Oral antibiotic treatment to destroy the bacteria causing the infection. (Antibiotics are given intravenously only in rare cases of severe infection.)
• Emptying the breast well and regularly by breast-feeding or pumping, which is essential to maintaining a good milk supply.

Most women can continue breast-feeding on the affected breast while an abscess heals. With your health professional's approval, you can cover the abscess area with a light gauze dressing while breast-feeding.

If you are advised to stop breast-feeding from the affected breast while an abscess heals, you can continue breast-feeding from the healthy breast. Be sure to pump or express milk from the infected breast regularly.

For more information on pumping or expressing breast milk, see the topic Breast-Feeding.

From the time you begin breast-feeding until your baby is weaned, take measures to prevent mastitis. For example, learn about different breast-feeding techniques so that you will know how to completely empty your breasts. Mastitis usually happens because a breast is not completely emptied of milk.

If you have symptoms of mastitis, contact your health professional right away. Delaying treatment can lead to an abscess forming in the affected breast. Severe infection can require intravenous antibiotics in the hospital.

Breast-feeding with mastitis

Along with oral antibiotic treatment, adequate emptying of the affected breast helps prevent more bacteria from collecting and may shorten the duration of the infection.

You can safely continue breast-feeding your baby or pumping breast milk to feed your baby during illness and treatment.¹ Your baby is the most efficient pump you have for emptying your breasts. Your breast milk is safe for your baby to drink because any bacteria in your milk will be destroyed by the baby's digestive juices.

• Before breast-feeding your baby, place a warm, wet washcloth over the affected breast for about 15 minutes. Try this at least 3 times a day. This increases milk flow in the breast. Massaging the affected breast may also increase milk flow.
• If possible, continue breast-feeding on both sides. Ideally, start on the affected side; it's critical that you empty this breast thoroughly. If this breast is too painful to start with, try feeding from the healthy breast first. Then, after your milk is flowing, breast-feed from the affected breast until it feels soft. Switch back to the healthy breast and breast-feed until your baby has finished.
• Pump or express milk from the affected breast if pain prevents you from breast-feeding. Nipple pain can be caused by the baby latching on to sore nipples. For more information on pumping or expressing breast milk, see the topic Breast-Feeding.

Self-care measures for mastitis

In addition to taking your prescribed antibiotics and continuing to breast-feed or pump breast milk, there are other steps you can take to make yourself feel better until the mastitis goes away.

• Take acetaminophen (such as Tylenol) to relieve your pain or discomfort. You can take ibuprofen (such as Advil) along with acetaminophen to reduce inflammation if necessary.
• Rest as much as possible.
• Apply ice packs to the affected breast to help reduce your pain. Place the ice outside of your bra or clothing. Do not put the ice directly on your bare skin.
• Drink extra fluids.
• If your breasts are overfull (engorged), pump or express a small amount of breast milk before breast-feeding. This will make your breasts less full and may make it easier for your baby to latch on to your breast.
• If pus is draining from your infected breast, wash the nipple gently and let it air dry before putting your bra back on. A disposable breast pad placed in the bra cup may absorb the drainage.

Most women can successfully continue breast-feeding during a breast infection. If mastitis makes it difficult for you to continue breast-feeding while the infection is being treated, remember that emptying your breasts regularly is essential. Don't hesitate to talk to your health professional or a lactation consultant for further help and support.

Organizations

• Breast Engorgement
• Breast-Feeding
• Thrush
• Weaning

Citations

1. Barbosa-Cesnik C, et al. (2003). Lactation mastitis. JAMA, 289(13): 1609–1612.

Other Works Consulted

• Sharma S, El-Refaey H (2003). Puerperal problems section of Postnatal problems. In DK James et al., eds., Evidence-Based Obstetrics, 2nd ed., pp. 393–401. Edinburgh: Saunders.

Author:	Amy Fackler, MA	Last Updated January 25, 2006
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Liisa Honey, MD, FRCSC - Obstetrics and Gynecology
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. For more information, click here.