Mastitis

Mastitis symptoms

What causes mastitis?

Mastitis can be either:

Non-infectious mastitis

This occurs when the build-up of breast milk irritates the breast tissue, making it become red, hot and swollen (inflamed).

Infectious mastitis

This occurs when the build-up of breast milk becomes infected and the infection spreads to the breast tissue. The infection is caused by germs (bacteria) which may have come from the skin.

If non-infectious mastitis is not treated, it can become infectious mastitis. You can't tell which type of mastitis it is from looking at it, and the treatment is the same.

You are more at risk of developing mastitis if you are a woman who is breastfeeding. It is sometimes called 'puerperal mastitis' or 'lactational mastitis'. It typically develops within the first few weeks of breast-feeding. Your milk flow is likely to drop from the affected breast. Read about lactational mastitis.

Can you get mastitis without breastfeeding?

Mastitis sometimes occurs in women who are not breastfeeding (non-lactational mastitis). Germs (bacteria) get into the milk ducts of the breast to cause the infection. This may be caused by a cracked nipple, a sore in the nipple or from a nipple piercing but it can happen when you don't have any problems with your nipples. Smoking can be a trigger because nicotine damages the ducts in your breasts.

How common is mastitis?

Breastfeeding mastitis typically develops within the first few weeks. At least 1 in every 10 breastfeeding women get mastitis, and it may be as many as 3 in every 10.

Mastitis when you're not breastfeeding is less common. Between 5-9 women out of 100 may have it.

How long does mastitis last?

If recognised and treated appropriately, mastitis should only last a few days.

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How is mastitis diagnosed?

Mastitis is recognised from the typical story and appearance. The breast is sore and you may feel unwell or have a high temperature. When looking at the breast there is a tender, red, hard and swollen area. This is usually wedge-shaped.

It can be difficult to tell if there is infection, but if you have a cracked nipple and pus is visible it may be more likely.

What else might it be?

Other conditions that cause a painful breast when you've just had a baby include engorged breast (when your milk first comes in) or a blocked duct.

If you have a red, sore breast and you haven't had a baby, depending on the story and how the breast looks your doctor may also consider cellulitis (bacterial infection of the skin), fat necrosis (happens after an injury to the area) or breast cancer. Inflammatory breast cancer is a less common type of breast cancer and the redness is more likely to be spread all over the breast, rather than in a wedge shape. In addition, because of swelling, your skin may look dimpled like the surface of an orange.

Mastitis treatment

• Eat well and drink lots of fluids.
• Get as much rest as you can.
• Avoid tight-fitting bras and clothing.
• Keep breastfeeding - it may be painful but this will help you get better. Feeding from an infected breast does not harm your baby. If your baby swallows germs (bacteria) from an infected breast, the germs will be killed by the acid in your baby's stomach.
• Placing a warm compress over your breast may help relieve the pain but evidence has found that cool compresses can ease symptoms between feeds. Compresses that are too hot or used too frequently have been found to worsen inflammation and increase swelling.
• Before feeding, massage your breast gently.
• Do not express milk from the breasts to empty them if you're breastfeeding as this can make the inflammation worse.
• If it is too painful to feed from the affected side, express the milk from that side with a breast pump.
• Pain can be managed with paracetamol and ibuprofen- use as per packet instructions. Breastfeeding mothers should avoid aspirin completely.
• See a midwife or doctor if you have any concerns.
• Ask your midwife or health visitor to check your breastfeeding technique and to check that your baby is latching on well.

The quickest way to get rid of mastitis is to continue breastfeeding. If you have tried the above measures for 24 hours you may need to see your doctor to be treated with a course of an antibiotics.

How to prevent mastitis

If you are breastfeeding the main prevention is to keep your milk flowing. Mastitis happens when milk flow stops.

If you have not had a baby prevention is less clear.

Are there any possible complications?

Occasionally, a breast abscess may form inside an infected section of breast. An abscess is a collection of pus that causes a firm, red, tender lump. This is thought to happen to between about 3 and 7 women with mastitis, out of every 100. If this happens to you, you will need to go to hospital for treatment.

The pus can be seen with an ultrasound scan. If the skin over the abscess is not broken, the pus can be drained with a needle and syringe by a doctor. If the skin is broken (or very thin) the doctor may need to make a small cut to let the pus drain out.