Mastitis

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Introduction

Mastitis (Breastfeeding)

Mastitis is a condition which causes a woman's breast tissue to become painful and inflamed. It's most common in breastfeeding women, usually within the first three months after giving birth.

If mastitis is caused by breastfeeding, doctors may refer to it as lactation mastitis or puerperal mastitis. Non-breastfeeding women often have a type called periductal mastitis.

Symptoms of mastitis

Mastitis usually only affects one breast, and symptoms often develop quickly. Symptoms of mastitis can include:

  • a red, swollen area on your breast that may feel hot and painful to touch
  • breast lump or area of hardness on your breast
  • a burning pain in your breast that may be continuous or may only occur when you are breastfeeding
  • nipple discharge, which may be white or contain streaks of blood

You may also experience flu-like symptoms, such as aches, a high temperature (fever), chills and tiredness.

When to seek medical advice

Contact your GP as soon as possible if you think you might have mastitis. It may help to try some self-help measures before your appointment.

It's important to see your GP promptly as mastitis could lead to a painful collection of pus (breast abscess), which may need to be drained surgically.

Causes of mastitis

In breastfeeding women, mastitis is often caused by a build-up of milk within the breast. This is known as milk stasis.

Milk stasis can occur for a number of reasons, including:

  • a baby not properly attaching to the breast during feeding
  • a baby having problems sucking
  • infrequent feeds or missing feeds

In some cases, this build-up of milk can also become infected with bacteria. This is known as infective mastitis.

In non-breastfeeding women, mastitis most often occurs when the breast becomes infected as a result of damage to the nipple, such as a cracked or sore nipple, or a nipple piercing.

Read more about the causes of mastitis.

Diagnosing mastitis

Your GP can often diagnose mastitis based on your symptoms and an examination of your breasts.

If you're breastfeeding, they may ask you to show them how you breastfeed. Try not to feel as if you're being tested or blamed - it can take time and practise to breastfeed correctly.

Your GP may request a small sample of your breast milk for testing if:

  • your symptoms are particularly severe
  • you've had recurrent episodes of mastitis
  • you've been given antibiotics and your condition hasn't improved

This will help determine whether you have a bacterial infection and allow your GP to prescribe an effective antibiotic.

If you have mastitis and aren't breastfeeding, your GP should refer you to hospital for a specialist examination and a breast scan to rule out other conditions, particularly if your symptoms haven't improved after a few days of treatment.

Scans you may have include an ultrasound scan or a mammogram (X-ray of the breast).

Treating mastitis

Mastitis can usually be easily treated and most women make a full recovery very quickly.

Self-help measures are often helpful, such as:

  • getting plenty of rest and staying well hydrated
  • using over-the-counter painkillers, such as paracetamol or ibuprofen, to reduce any pain or fever
  • avoiding tight-fitting clothing - including bras - until your symptoms improve
  • if you're breastfeeding, continuing to feed your baby and making sure they are properly attached to your breast

Breastfeeding your baby when you have mastitis, even if you have an infection, won't harm your baby and can help improve your symptoms.

It may also help to feed more frequently than usual, express any remaining milk after a feed, and express milk between feeds.

For non-breastfeeding women with mastitis and breastfeeding women with a suspected infection, a course of antibiotic tablets will usually be prescribed to bring the infection under control.

Read more about treating mastitis.

Preventing mastitis

Although mastitis can usually be treated easily, the condition can recur if the underlying cause isn't addressed.

If you're breastfeeding, you can help reduce your risk of developing mastitis by taking steps to stop milk building up in your breasts, such as:

  • breastfeed exclusively for around six months, if possible
  • encourage your baby to feed frequently, particularly when your breasts feel overfull
  • ensure your baby is well attached to your breast during feeds - ask for advice if you're unsure
  • let your baby finish their feeds - most babies release the breast when they've finished feeding; try not to take your baby off the breast unless they're finished
  • avoid suddenly going longer between feeds - if possible, cut down gradually
  • avoid pressure on your breasts from tight clothing, including bras

Your GP, midwife or health visitor can advise about how to improve your breastfeeding technique. You can also call the National Breastfeeding Helpline on 0300 100 0212 for advice.

Causes

Causes

Mastitis can be caused by a build-up of milk within the breast (milk stasis) or damage to the nipple, which may lead to a bacterial infection.

Mastitis in breastfeeding women

Milk stasis

Many cases of mastitis in breastfeeding women are thought to be caused by milk stasis. This occurs when the milk isn't properly removed from your breast during breastfeeding.

It can be caused by:

  • a baby not properly attaching to the breast during feeding - this may mean that not enough milk is removed; see breastfeeding position and attachment for advice on helping your child feed correctly
  • a baby having problems sucking - for example, because they have a tongue-tie, a piece of skin between the underside of their tongue and the floor of their mouth
  • infrequent or missed feeds - for example, when they start to sleep through the night
  • favouring one breast for breastfeeding - for example, because one of your nipples is sore; this can lead to milk stasis developing in the other breast
  • a knock or blow to the breast that damages the milk duct or the glands in your breast
  • pressure on your breast - for example, from tight-fitting clothing (including bras), seat belts or sleeping on your front

Milk stasis can cause the milk ducts in your breasts to become blocked, and can cause milk to build up within the affected breast.

Experts aren't sure exactly why breast milk can cause the breast tissue to become inflamed. One theory is that the pressure building up inside the breast forces some milk into the surrounding tissue.

Your immune system may then mistake proteins in the milk for a bacterial or viral infection and responds by inflaming the breast tissue in an effort to stop the spread of infection.

Infection

Fresh human milk doesn't usually provide a good environment in which bacteria can breed. However, milk stasis can cause milk to stagnate and become infected. This is known as infective mastitis.

Exactly how bacteria enter the breast tissue hasn't been conclusively proven.

The bacteria that usually live harmlessly on the skin of your breast may enter through a small crack or break in your skin, or bacteria present in the baby's mouth and throat may be transferred during breastfeeding.

You may be at greater risk of developing infective mastitis if your nipple is damaged - for example, as a result of using a manual breast pump incorrectly or because your baby has a cleft lip or palate, an opening or split in their lip or roof of their mouth.

Mastitis in breastfeeding women is more likely to be caused by an infection if self-help measures to express milk from the affected breast haven't improved symptoms within 12 to 24 hours.

Read more about treating mastitis.

Mastitis in non-breastfeeding women

In women who don't breastfeed, mastitis is often caused by a bacterial infection. This can occur as a result of bacteria getting into the milk ducts through a cracked or sore nipple, or a nipple piercing.

This type of mastitis is known as periductal mastitis. It usually affects women in their late 20s and early 30s, and is more common among women who smoke.

Occasionally, mastitis can occur in non-breastfeeding women as a result of duct ectasia. This is when the milk ducts behind the nipple get shorter and wider as the breasts age. It typically occurs in women approaching the menopause.

Duct ectasia is usually nothing to be concerned about, but in some cases a thick, sticky secretion can collect in the widened ducts, and this can irritate and inflame the duct lining.

Treatment

Treatment

Mastitis can usually be easily treated and most women make a full recovery very quickly.

Self-help tips

Many cases of mastitis that aren't caused by an infection often improve through using self-care techniques, such as:

  • making sure you get plenty of rest
  • drinking plenty of fluids
  • using over-the-counter painkillers such as paracetamol or ibuprofen to reduce any pain or fever - a small amount of paracetamol can enter the breast milk, but it's not enough to harm your baby (it's not safe to take aspirin while breastfeeding)
  • avoiding tight-fitting clothing, including bras, until your symptoms improve
  • if you're breastfeeding, regularly expressing milk from your breasts
  • placing a warm cloth soaked with warm water (a compress) over your breast to help relieve the pain - a warm shower or bath may also help

If your GP thinks your mastitis is caused by an infection, you may need to take antibiotics

Expressing breast milk

If you're breastfeeding and you have mastitis, it's likely to be caused by a build-up of milk within the affected breast. Regularly expressing milk from your breast can often help improve the condition quickly.

One of the best ways to express milk from your breast is to continue breastfeeding your baby, or expressing milk by hand or using a pump. Continuing to breastfeed your baby won't harm them, even if your breast is also infected.

The milk from the affected breast may be a little saltier than normal, but it's safe for your baby to drink. Any bacteria present in the milk will be harmlessly absorbed by the baby's digestive system and won't cause any problems.

You may find that expressing breast milk becomes easier by:

  • breastfeeding your baby as often and as long as they're willing to feed, starting feeds with the sore breast first
  • making sure your baby is properly positioned and attached to your breasts - your midwife or health visitor will advise you about how to do this; read more about breastfeeding positioning and attachment
  • experimenting by feeding your baby in different positions
  • massaging your breast to clear any blockages - stroke from the lumpy or tender area towards your nipple to help the milk flow
  • warming your breast with warm water - this can soften it and help your breast milk flow better, making it easier for your baby to feed
  • making sure your breast is empty after feeds by expressing any remaining milk
  • if necessary, expressing milk between feeds - see expressing breast milk for more information

Contact your GP if your symptoms worsen or don't improve within 12 to 24 hours of trying these techniques. If this happens, it's likely that you have an infection and will need antibiotics.

Antibiotics

If you're breastfeeding and the above measures haven't helped improve your symptoms, or your GP can see your nipple is clearly infected, you'll be prescribed a course of antibiotics to kill the bacteria responsible. These should be taken in addition to continuing the self-help measures above.

Your GP will also usually prescribe a course of antibiotics if you develop mastitis and aren't breastfeeding.

If you're breastfeeding, your GP will prescribe a safe antibiotic. This will usually be a tablet or capsule that you take by mouth (orally) four times a day for up to 14 days.

A very small amount of the antibiotic may enter your breast milk, which may make your baby irritable and restless. Their stools may become looser and more frequent.

This is usually temporary and will resolve once you've finished the course of antibiotics. They don't pose a risk to your baby.

Contact your GP again if your symptoms worsen or haven't begun to improve within 48 hours of starting antibiotic treatment.

Surgery

Surgery to remove one or more of your milk ducts may be recommended in some cases in non-breastfeeding women that recur frequently or persist despite treatment.

This operation is usually performed with a general anaesthetic where you're asleep, and lasts about 30 minutes. Most people can go home the same day as the procedure or the day after.

If all of the milk ducts in one of your breasts are removed during this operation, you'll no longer be able to breastfeed using that breast. You may also lose some sensation in the nipple of the treated breast(s).

Make sure you discuss all the risks and implications of surgery with your doctor and surgeon beforehand.