Experiencing a sore or tender breast, noticing a change in colour in a specific area of the breast, or detecting a hard spot or small lump can be quite concerning. In such cases, it’s natural to wonder if it could be mastitis. So, what steps should you take now?
Regardless of the reason for your sore breast, consider the following measures:
- Breastfeed your baby as frequently as they desire.
- Take time to rest and allow your body to recover.
- Apply ice or cold packs to alleviate discomfort in the tender area.
- If engorgement is an issue, you may want to consider lymphatic drainage. This technique involves a gentle, light touch using flat fingertips in the armpit area and upper chest. To witness a demonstration of lymphatic drainage massage, you can refer to this informative video.
- Consult with your healthcare provider and discuss the possibility of using ibuprofen in alternating doses with paracetamol.
It’s worth noting that what was previously believed to be distinct breast problems, such as mastitis, blocked ducts, milk blister “blebs,” and abscesses, are now understood to be stages in the process of inflammation—a response of the body to potential threats.
Your breasts contain a network of tiny ducts through which milk flows. These ducts are easily compressed. When your body produces more milk than your baby consumes (e.g., due to pumping in addition to breastfeeding) or when tight clothing or a bra strap puts pressure on your breasts, it can trigger a response from your body as if it were a threat. This response involves the influx of inflammatory cells and fluids to aid in the repair process and combat bacteria. As a result, swelling occurs, which can exert pressure on the ducts and impede the smooth flow of milk. The affected area may appear darker, redder, or pinker than usual, and in darker skin, redness may be less noticeable or even absent. Additionally, the area may feel warm to the touch. If left untreated, this inflammation can worsen or become infected. Several factors can contribute to this condition:
- Prolonged periods of separation between feedings, where you and your baby are apart for longer durations than usual.
- Your baby’s increased sleeping duration at night.
- Teething, a stuffy nose, or other factors that may cause your baby to feel out of sorts and nurse less frequently.
To address blocked/clogged/plugged ducts or mastitis, you may consider the following suggestions:
- Prioritize your well-being and rest, treating yourself as if you were sick. Focus on self-care, caring for your breast, and tending to your baby.
- Apply cold or ice packs to the affected area for relief.
- Keep in mind that antibiotics may not be immediately recommended. At the initial stage, this condition is not an infection, and prescribing antibiotics might promote the development of resistant bacterial strains, increasing the likelihood of recurrent mastitis or abscesses in the future.
- Ensure that you breastfeed responsively, following your baby’s cues, to avoid unintentionally prolonging the intervals between feedings. Maintaining a good match between your baby’s needs and your milk production rate is important. For more information on feeding frequency, consult our FAQs.
- Minimize excessive pumping, as it can disrupt the balance between your milk
Manifestations, Indications, and Therapeutic Approaches
Detect a firm, tender lump in your breast Experience fatigue, body aches, or weariness Develop a low-grade fever below 101°F (38.4℃) Observe alterations in the appearance of the affected breast’s skin, which may display shades of red, pink, brown, or grey depending on your skin tone and the inflamed area. Some nursing mothers have described these changes as triangular or “wedge” shaped, although the absence of such skin transformations does not exclude the presence of mastitis. Then:
Rest as much as possible, preferably lying in bed with your baby. Keep essential supplies such as diapers, wipes, toys, books, your phone, a water container, and snacks nearby to minimize the need to leave the bed. Continue applying cold or ice packs as frequently as desired to reduce inflammation and swelling. Maintain breastfeeding your baby on demand, aiming for 8-12 feedings every 24 hours from both breasts.
Nursing toddlers or older children may feed less frequently. If your baby refuses to feed on the sore side, you might need to express or pump some milk until the breast becomes as softened as it typically feels after a feeding. To alleviate engorgement, consider utilizing lymphatic drainage techniques, which involve gentle, light yet firm touch with flat fingertips on the skin in the armpit area and upper chest.
Consult your healthcare provider regarding the potential use of medications like Ibuprofen to reduce inflammation, alternating with acetaminophen/paracetamol for pain relief. Probiotics, when consumed by the mother, may offer some assistance in managing mastitis. Two strains that have been studied and shown potential benefits are Limosilactobacillus fermentum and Ligilactobacillus salivarius. However, the authors highlight the need for further research in this area. If you:
Do not experience any improvement or worsen within the first 24-48 hours Develop a fever of 101°F (38.4℃) or higher Then:
Contact your doctor or primary healthcare provider promptly. If antibiotic medication is prescribed, complete the recommended course even if you start feeling better. Continue resting and ensure an adequate intake of fluids. Sustain breastfeeding. If your baby is unwilling or unable to feed on the affected side, gently hand express or pump milk (avoid excessive pumping). Discuss the potential use of therapeutic ultrasound (TUS) with your healthcare provider. TUS, if available in your region, may help alleviate edema (swelling and excess fluid in the breast) and reduce inflammation. If no improvement is observed after 48 hours, it might be appropriate to inquire about the possibility of culturing your milk, depending on the recommendation and availability of such services. It’s worth noting that milk cultures may not be universally accessible, and their interpretation can be challenging.
An abscess refers to a swollen area within the breast that contains pus and bacteria, enclosed by tissue. This occurrence is relatively rare in cases of mastitis. Typically, it presents as a highly reddened or dusky region in light-skinned breasts. However, in darker skin, redness may be challenging to detect or entirely invisible.
The affected feels hardened upon touch, accompanied by significant tenderness. The lump may exhibit temporary improvement followed by a worsening condition, or symptoms may escalate until drainage of the abscess becomes necessary.
In certain instances, the abscess may naturally rupture and discharge through the skin. If drainage is required, a physician (typically a radiologist or breast surgeon) will either perform multiple needle aspirations to extract the abscess contents or insert a drain that remains in place until the abscess is fully drained. Surgical intervention under anaesthesia may be necessary in some cases. Additionally, if an abscess is present, antibiotics will likely be prescribed. Regardless of the method employed to address the abscess, continued breastfeeding on the affected breast plays a crucial role in reducing inflammation.
PREVENTING RECURRENCE OF BLOCKED DUCTS/MASTITIS
To ensure future inflammatory issues are minimized, it is crucial to pay attention to the time gaps between breastfeeds. Varying your baby’s feeding positions and ensuring a proper latch can promote milk flow from all the ducts. Maintaining good overall health through a balanced diet and sufficient rest can also help prevent breast soreness. It is advisable to gently examine your breasts daily, and if you notice any tenderness, make sure to rest, apply cold packs, and continue breastfeeding or expressing milk to reduce inflammation.
Recurrent mastitis can occur for various reasons. Resistance or insensitivity of bacteria to prescribed antibiotics, or incomplete antibiotic courses, may lead to recurrence. Similarly, if breastfeeding is discontinued on the affected side or if the initial cause of mastitis remains unresolved, recurrence becomes more likely.
If mastitis recurs, consult your healthcare provider about the possibility of conducting a culture and sensitivity test on your milk. This test can identify the causative organism and determine the most effective antibiotic treatment.
The prevalence of antibiotic-resistant bacteria is increasing, resulting in more severe infections, including mastitis. Ineffective antibiotic use, especially when used repeatedly, raises the risk of bacterial resistance. This can eventually lead to the formation of an abscess.
OTHER CAUSES OF MASTITIS AND PREVENTIVE MEASURES
Frequent pumping, either to build up a milk supply in the freezer or completely empty the breasts, can lead to dysbiosis and inflammation due to increased milk production.
Exclusive pumping can affect the microbiome because there is no feedback from the baby’s saliva to the nipple. The suction pressure from pumps may differ from the infant’s suction during breastfeeding. Excessive suction pressure can cause breast and nipple trauma, leading to inflammation and an increased risk of mastitis.
Conversely, insufficient suction pressure can result in inadequate milk removal and subsequent breast inflammation. Pumping is generally less efficient than direct breastfeeding, potentially contributing to an imbalance of bacteria in the ductal system. To minimize these risks, it is important to carefully select the appropriate pump flange size and regularly inspect the nipple and areola after pumping.
Some babies may exhibit reluctance to feed, experience difficulties with latching, or refuse the breast due to nursing strikes or other factors. Sudden changes in breastfeeding patterns can contribute to inflammation. It is common for problems with inflammation to arise during holidays or when hosting guests, as feedings may be delayed more than usual due to busy schedules.
To avoid breast discomfort, ensure that your clothing, especially your bra, is not overly tight-fitting.
Certain bras and bathing suits, particularly those with underwires, can exert excessive pressure on specific areas of your breast. Similarly, carrying a heavy purse or bag with a strap that crosses your breast or using baby carriers can lead to problems. To mitigate these risks, consider frequently changing the side on which you carry bags or purses, as well as altering how you wear carriers, slings, and wraps.
Changing sleep positions throughout the night can help alleviate pressure on the breasts. Wearing a stretchy sleep bra or camisole bra top may also provide relief and reduce the need to wear a bra while sleeping.
The shoulder strap of a seat belt can cause discomfort in the breast, especially if it’s too tight. Additionally, the pressure from the shoulder strap during sudden stops can lead to breast soreness. When embarking on long car trips, it is helpful to periodically take breaks and breastfeed the baby to relieve pressure from the seat belt.
Breastfeeding challenges can sometimes evoke feelings of anxiety or sadness. Anxiety may lead to excessive pumping in an attempt to create a breast milk stash, potentially resulting in inflammation. If you experience such emotions, it is important to reach out to a La Leche League Leader and consult your healthcare provider.
At times, mastitis may arise due to difficulties with positioning and latch that affect how efficiently your baby extracts milk from your breast.
TREATMENTS THAT ARE NO LONGER RECOMMENDED
Certain treatments that were previously recommended for mastitis are now considered ineffective or potentially harmful. These include:
- Applying heat to the breast or soaking in warm water.
- Engaging in vigorous, deep massage, or squeezing to alleviate a clog.
- Using gravity by dangling over the baby during feeding to dislodge a clog.
- Employing a comb, vibrator, or electric toothbrush on the breast.
- Attempting to “empty” the breast through excessive pumping or breastfeeding, which can stimulate further milk production.
- Initiating antibiotics at the onset of symptoms.
- Using Epsom salts in a Haakaa or similar silicone breast pump for nipple blebs.
- Applying saline soaks, warm compresses, olive oil, castor oil, or other oils to the breast or nipple skin.
- Removing the skin or “popping” a bleb, as it may lead to infection.
- Routine sterilization of pumps and household items is unnecessary, but it is important to clean them daily following the manufacturer’s instructions to avoid infection.