Mastitis: What to Look For & More

My recent face-to-face encounter with mastitis made me realize – although I have written briefly about in other posts, I’ve never really covered it in-depth. I also wanted to share my story of my experience with mastitis, because it wasn’t exactly what I expected to be like so I thought it might be valuable for others to read about.

*Disclaimer: This blog is intended for informational purposes only. The information on this blog should not be used as a substitute to medical advice or medical treatment. As always, your Primary Care Provider, a doctor, or another health professional is your best resource for specific questions and medical advice. If you believe you or a loved one are experiencing a medical emergency, please contact 911.*

So, what is mastitis?

Put simply: inflammation of the breast.

It is common and it occurs mostly in women who are breastfeeding (but it can happen at any time – see below).

It may involve an infection, but it doesn’t have to – there is also non-infectious mastitis. The non-infectious version is often caused by duct ectasia (read here) and sometimes can be caused by something such as a foreign body, resulting in a localized reaction (think nipple piercings for example).

When mastitis is caused by an infection, it it considered lactational or non-lactational – meaning it is either related to breastfeeding and/or pregnancy, or occurs in non-breastfeeding women, respectively.

There are also a few other types of mastitis such as tubercular mastitis and the rare granulomatous mastitis.

The focus of the post is on lactational mastitis.

What causes lactational mastitis?

Lactational mastitis is caused by bacteria, and is usually related to milk stasis – meaning milk is staying still, so either you aren’t feeding/pumping enough or the breast is not being emptied entirely. It can also develop in relation to an obstruction of flow (again – causing milk stasis). So, bacteria enters the breast and it finds a lovely breeding ground!

Something I compare it to is stagnant water – often many things “breed” in stagnant water.

Bacteria can come from your baby’s mouth or even from your own skin. It enters the breast via small cracks in the nipple. It is easy to see why this is common, especially in those early months of breastfeeding, when you tend to be more likely to have cracks or sores on the nipples.

What are the symptoms?

Commonly reported symptoms of mastitis include:

  • Pain in the breast – it can be similar in ways to a clogged duct (I will talk about the differences after)
  • Feeling “flu-ish” or unwell with fatigue and muscle aches
  • Fever (but not always)
  • Other breast related symptoms such as redness/streaking (not visible on all skin tones so look for other symptoms as an indicator!), warmth, swelling, etc.

When mastitis worsens, you may also experience swelling in the axillary lymph nodes (armpit, on the same side of the affected breast) and tachycardia (increased heart rate).

What is the difference between mastitis and plugged duct in regards to symptoms?

They may initially be hard to differentiate – from my personal experience, mastitis began feeling very similar to a clogged duct (which I have had twice before). A localized area of discomfort in my breast, with warmth and tenderness.

However, mastitis usually is more painful or has more pronounced symptoms. Two things that led me to question whether or not I had a clogged duct or mastitis were:

  1. I had some red streaking on my breast – it was nothing extreme (if you google photos of mastitis, you’ll see that some people very obviously have signs of mastitis – I did not) but still not something that had happened with previous clogs
  2. I felt generally unwell – I was feeling fatigued, a little bit nauseated; my skin became sensitive like it does when I have a fever; and I had muscle aches

To learn more about symptoms & the differences between a clogged duct and mastitis please read Kellymom’s page here.

What surprised me was that I did not have a fever. I almost contemplated not calling my PCP because I thought – well how can it be mastitis if I don’t have a fever? However, the good people of #momtwitter and #medtwitter encouraged me to call after I shared my symptoms – and I am thankful for that as my initial intuition about something being “off” was right!

Why do I need to be concerned about mastitis?

Well, other than the fact that we are usually concerned about infection for a variety of reasons..

One of the complications of lactational mastitis specifically is breast abscess, which often feels like a hard lump in the tissue. An abscess is just a collection of fluid or pus – in this case, within the breast tissue. An abscess usually requires drainage or aspiration. Treatment may also involve antibiotics.

How is it treated?

See treatment for breast abscess briefly above.

Treatment that you can do at home includes:

  • Feeding and pumping – mastitis is not harmful for your baby, and it’s important to continue to nurse (or pump, hand express, or massage your breasts)
  • Warm compress on the breast, or a warm shower
  • Potatoes – wait what?! Slices of raw potato are actually recommended by midwives to relieve pain and swelling in the affected breast
  • Avoid tight clothing or restrictive bras
  • Analgesia for pain
  • Rest – as much as you can as a parent!

If there are no signs of systemic infection (such as fever, feeling unwell, etc.) then often just these things are enough to resolve the mastitis (and this is the recommendation of the Academy of Breastfeeding Medicine). However – if you have symptoms that are concerning to you it is always important to contact your HCP. Actually, I would say contact your HCP if you suspect you have mastitis for any reason – only because you do not want to wait for it to worsen. Even your phone call just involves you having a quick conversation and reassurance – it can be worth it. I’m sure most HCPs would agree they’d rather you discuss and bring up these things than keep it to yourself if you’re concerned. Some more seasoned mamas may feel comfortable waiting the 12-24 hrs before becoming concerned – you know your body.

I also say this because of my experience – I did not have a fever for example. I waited about 12 hrs before I called (the recommendation is to call if no improvement is seen within 12-24 hrs) but I thought about waiting longer. I called more for reassurance and I’m glad that I did.

Additional treatment might include antibiotics. Kellymom has a great list of times when you should reach out to your doctor ASAP to potentially start on antibiotic therapy here. Antibiotics for treatment can be taken while you continue to breastfeed – speak to your prescribing provider if you have concerns.

I personally was prescribed antibiotics for treatment, and my doctor advised me (similar to what Dr. Newman has explained on this page) to take them within a certain amount of time if I felt worse or not improved. They gave me a window to assess how I felt and go from there, which was helpful.

I would recommend reaching out if you have any concerns – you know your body best, and if something doesn’t feel right and you’re not 100% sure how to approach it, asking your OB/midwife/physician/etc. may be a more difficult route to an answer (due to phone line wait times and so on) it is the safest one for a reliable answer. That doesn’t mean that you can reach out to your social circles regarding your concerns – even I did that! Sometimes you just need to hear that something is “normal” or “expected”; or that it isn’t, and it reassures you that calling your provider is the right thing to do. However, keep in mind that although experience is valuable it does not replace medical advice from a medical professional.

Take-away message re: mastitis – Don’t. Stop. Nursing!! I think it’s a common misconception that you should stop nursing because you have an infection, but if you can bear it, you should try to continue! Otherwise you may have to hand express on that side if it is too painful.

As always – you know your body and are your best advocate; and your provider is an excellent resource for any information specific to you!