Breast inflammation due to breastfeeding (mastitis)

What is a breast inflammation (mastitis) of breastfeeding?

Simply put, an inflammation of breast tissue in women that breastfeed.
It is important to differentiate between two situations that can occur in sequence of the same process:
1) Breast inflammation that is not infectious caused by the body’s reaction to a blocked milk duct.
2) Breast infection – involving bacteria.
In general, inflammation and thus infection develop in the body where there are fluids that are stagnant and not well drained, serving as a rich food-base for bacteria. Therefore, infection frequently develops secondary to inflammation, for example if blocked milk ducts are not opened and the milk is not drained.

What causes breast inflammation (mastitis) of breastfeeding?

Breast inflammation of breastfeeding occurs in 2-10% of women that breast feed, mostly during the first weeks to months of breastfeeding (note the main causes will be discussed soon, most commonly early in life).
Recall that the initial problem is due to a disruption in the flow of milk through the ducts. Therefore, most inflammation develops when there is difficulty breastfeeding leading to swelling and accumulation of milk, such as:
– A blockage in one of the milk ducts.
– Reduced frequency of feeds.
– Sudden or rapid weaning.
– Inefficient latching by the baby leading to ineffective drainage.
– Overproduction of milk.
– Injured nipples with or without infection.
– Illness of the mother and/or baby.
– Use of varied creams on nipples or pumps.
– Extreme fatigue of the mother.

What are the bacteria that cause infectious inflammation of the breast?

The most common bacteria is Staphylococcus aureus whom you have already met on other pages of this site (mostly on the topic is skin infections which can be read here). There are other bugs involved like Streptococcus (Group A Strep known best from throat infections and Group B), E. coli, anerobic bacteria, and more.

What are the signs and symptoms of mastitis from breastfeeding?

In the early stages there is a feeling of breast congestion due to blocked milk drainage. Later signs are like all type of inflammation – pain, redness of the skin that is warm to the touch and occasionally swollen. As the process continues and infection begins, all these symptoms increase (more redness, hotter to the touch, and the appearance of localized stiffness) – at this stage fever can occur with general malaise similar to that of the flu (chills, aches, weakness, etc.).
Ultimately, the infectious can cause a breast abscess (an accumulation of pus in the area of inflammation and infection). Sometimes it is possible to palpate enlarged, reactive lymph nodes in the armpit on the side of the inflamed breast.

How is mastitis from breastfeeding diagnosed?

The diagnosis is clinical – an examination by a physician as per the breastfeeding mothers’ complaints and findings on breast exam.
There is no need for laboratory testing in most cases and usually we are unable to isolate a specific bacterium that caused the infection.

Extremely rare – in severe infections that do not respond to treatment it is possible to send a bacterial culture from the milk to isolate the causal bacteria and assess a susceptibility profile to various antibiotics.
Furthermore, in infections that do not respond within 2-3 days sometimes ultrasound is often employed to assess the development of an abscess.

How do you treat mastitis from breastfeeding?

We will start with the most important part – not only is there no recommendation to limit or avoid breastfeeding when there is an infection (even if mom is receiving antibiotics), it is the mainstay of treatment!
Prevention and treatment of infection is via draining of the fluids.
And another important point – continuing breastfeeding is not dangerous to the baby.
So the first treatment recommendation is the try and drain the breast repeatedly and efficiently – frequent feedings, pumping, hot compresses, and pressing/squeezing with hand massage. It is painful and it will hurt but eventually it will cause relief. Remember that feeding from the other breast can also help express milk in the infected breast.
For pain, over the counter pain killer such as Ibuprofen (which are obviously permitted while breastfeeding) as well as cold compresses after feeding can help. And rest.
This is a serious infection that is painful and emphasizing rest and draining of the breast will allow you to recover.
If there is no improvement within 24 hours and, of course, if the symptoms get worse – it is likely that an ascending infection has developed, and antibiotic therapy should be considered. In these cases, examination by physician should be performed.

Which antibiotic will the doctor prescribe for mastitis?

Treatment is directed at the most common bacterial cause (Staphylococcus aureus), therefore Cephalexin for 7-10 days is a great choice. The regular dose is 500 milligrams (1 tablet) 3 times per day. In severe cases it is permissible to double the dose.
Some treat with Amoxicillin and Clavulanate (a tablet of 875 milligrams, twice daily) due to the thought that the source of infection is oral bacteria in the baby. In my opinion, in most cases, there is no need to treat with such broad spectrum antibiotics, especially as the side effects of Amoxicillin and Clavulanate are less pleasant.
Most importantly – both antibiotics are safe to use while breastfeeding.
In cases of abscess development, drainage of pus should be considered and the patient should be referred to a surgical consultation.
Remember the importance for returning for a repeat examination if there is no improvement while receiving treatment of if there is development of redness, swelling or stiffness of the breast after completing treatment.

Can you prevent breastfeeding associated mastitis?

The mainstay of prevention is breastfeeding as needed without limitation, primarily with the breast feels congested. It is important to employ good breastfeeding technique so that the baby can drain the breast well. If the breast is full and the baby does not want to breastfeed, attempting to pump can help relieve congestion.
It is important to treat cracked and painful nipples.
Do not hesitate to receive guidance from good and qualified breastfeeding consultant.
Some authorities recommend avoiding tight-fitting bras or carriers that press against the breasts as they can increase the risk of blocked milk ducts. In my opinion a good rule of thumb is that whatever you wear should be comfortable.

In summary, mastitis is a common complication of breastfeeding. It is painful and annoying. Quick diagnosis and efficient treatment can help most mothers receive appropriate care at home.
Remember that the key to efficient treatment is not to stop breastfeeding but rather to continue and ensure good and effective feeding.