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Mastitis is one of those breastfeeding challenges that can feel frightening when it arrives, often suddenly, and usually at the worst possible time!  Understanding what's happening and knowing what to do can make a real difference to how quickly you recover and whether you're able to continue breastfeeding.

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What is mastitis?

Mastitis is now understood as a spectrum of conditions rather than a single diagnosis. It begins with oversupply and milk stasis, can progress to painful inflammation and narrowing of the milk ducts previously called a blocked duct and in some cases progresses further to inflammatory or infective mastitis. Understanding where you are on that spectrum matters for how it's managed. Mastitis affects an estimated 1 in 10 breastfeeding women, most commonly in the first few months after birth, though it can happen at any stage.

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Signs of mastitis

A hard, tender, red or swollen area on one breast
Skin that feels warm or hot to the touch
Flu-like symptoms, aching, chills, fatigue, fever
Pain during or between feeds
A general feeling of being suddenly and significantly unwell

Mastitis tends to come on quickly. Many mums describe feeling fine in the morning and completely floored by the afternoon.

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What the updated evidence says about treatment

Guidance on mastitis has changed significantly in recent years and some older advice including vigorous breast massage and applying heat is no longer recommended as it can worsen inflammation.

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Current evidence-based recommendations include:

Keep feeding from the affected breast this remains important. Stopping feeds causes milk to build up further and worsens inflammation
Apply cold or ice packs to the affected area cold reduces inflammation more effectively than heat, which can increase it
Take ibuprofen if you're able to, it reduces both pain and inflammation and is safe while breastfeeding
Rest as much as possible, mastitis hits harder when you're run down
Stay well hydrated
Avoid vigorous breast massage, this is no longer recommended as it can cause further tissue trauma and worsen the condition
Minimise pumping beyond what's needed for comfort, excessive pumping can overstimulate supply and perpetuate the cycle

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What about antibiotics?

Because most cases of mastitis are caused by inflammation rather than infection, a short trial of conservative management such as cold packs, ibuprofen, continuing to feed is often sufficient. If symptoms are not improving within 24–48 hours, or if you have a high fever and feel significantly unwell, see your GP who may prescribe antibiotics. These are safe to take while breastfeeding.

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When to see your GP urgently

Fever of 38.5°C or above
Symptoms worsening despite conservative management after 24–48 hours
The red area is spreading
You develop a soft, fluid-filled lump, this may indicate an abscess requiring further treatment

‍Prevention

‍The most effective prevention is a good latch and effective milk transfer at every feed. If your baby isn't draining the breast well, the risk of mastitis is significantly higher. Avoiding oversupply if possible, feeding on demand rather than pumping excessively also reduces risk. If you are in Jersey and dealing with mastitis or recurrent blocked ducts, get in touch. Getting your latch properly assessed is often the most important step.

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