What Is Mastitis?

If you're a chest- or breastfeeding parent, you've probably encountered mastitis (or heard of others who have). Mastitis—which is characterized by inflammation and pain in the breast, and often causes flu-like symptoms—affects 2 to 30% of lactating people. And while mastitis is treatable and can, in most cases, be prevented, it remains one of the top reasons why people stop breastfeeding.

But knowledge is power. Understanding what the first signs of mastitis are, what the best treatment options are, and how to prevent it in the first place can save you tons of stress and help ensure your breastfeeding journey is a positive one.

We connected with a breastfeeding medicine physician as well as an OB-GYN to learn more about mastitis, and what the most updated treatment protocols are.

What Is Mastitis?

Mastitis is usually confined to one breast, and is often experienced as a tender, painful, soreness in the breast. Mastitis used to be described as a clogged milk duct that became infected. But new research from the Academy of Breastfeeding Medicine (ABM) now describes mastitis as widespread inflammation in the breast, affecting the ducts, the alveoli, and the breast connective tissue.

The ABM explains that mastitis is caused by swelling and edema caused by hyperlactation (overproduction of milk) and mammary dysbiosis, which refers to changes in your milk microbiome. Mammary dysbiosis is influenced by genetics, certain medical conditions, and use of antibiotics and probiotics. Pumping more milk than your baby needs can lead to milk overproduction, which can increase your chances of developing mastitis.

Mastitis is most common in the first six weeks of breastfeeding (which is also when you are most prone to hyperlactation) and tends to subside by three months.

What Are the Signs of Mastitis?

Because mastitis is a widespread infection—one which causes pain and inflammation—if you come down with a case of mastitis, you will most likely know it. Mastitis symptoms can be intense and challenging. "Typically, the first sign of mastitis is breast pain and the affected breast may become swollen," says Sarah Jordan, MD, OB-GYN at Pediatrix Medical Group in Fort Worth, Texas.

Other common symptoms of mastitis can include:

• Tenderness, soreness, and pain on one breast
• An engorged breast that is warm to the touch
• Red streaks or red area on your breast
• A hard or firm area in the breast
• Fever
• Chills
• Exhaustion

How Is Mastitis Diagnosed?

Mastitis is diagnosed based on your symptoms, breastfeeding history, and (sometimes) an in-person examination of you and your breasts. If you are experiencing the classic signs of mastitis, like sore, tender, breasts along with flu-like symptoms, you should reach out to a health professional or lactation consultant. Most providers will be able to diagnose you based on your description or symptoms alone, since mastitis has several specific, tell-tale signs.

What Is the Treatment for Mastitis?

Mastitis treatment is twofold. Doctors and/or health care providers can and should provide pain management options and, if the case is bacterial, antiobiotics may be needed. But how do you know if you need to seek medical attention for mastitis? Does mastitis ever go away on its own?

"It is very important to treat mastitis," says Dr. Jordan. "If left untreated, an abscess may form that could cause you to become very sick and require surgical treatment." Signs of breasts abscesses are similar to mastitis, but usually involve a more localized tender lump or what feels like a mass on the breast; discharge may also be present.

In some cases, at home-measures work fine for mastitis, but at times, mastitis requires antibiotics, says Stephanie Sublett MD, OB-GYN, IBCLC, and owner of Ready to Slay Mama, an online platform for breastfeeding and postpartum resources. Mastitis can be non-infectious and infectious, she explains, and treatment will depend on what type of mastitis you have.

"Non-infectious mastitis will typically resolve on its own within 24 hours with conservative management—ice, rest, Tylenol, or ibuprofen," she says. "Infectious mastitis is suspected when symptoms have not resolved within 24 hours of conservative management or systemic symptoms are present like fevers/chills, and body aches." If you have these symptoms for 24 hours, antibiotics will be necessary, Dr. Sublett says.

In the past, it was advised that people who have mastitis try to pump or nurse more frequently than usual, to remove the excess, clogged up milk. But ABM actually advises against that now. They also discourage vigorous massage of the breast. The new ABM guidelines for mastitis at-home care include:

• Breastfeed and pump normally; don't overdo it
• Apply cold compresses to your breast, not heat
• Light massage is fine, but don't apply strong pressure to your breast
• Use physician-approved pain relief medication for soothing

Is It Safe to Breastfeed With Mastitis?

If you are feeling sick and have a tender spot on your breast, it's understandable that you might feel concerned that your milk won't be safe for your baby or that breastfeeding isn't a good idea. But you can be assured that it's perfectly fine to continue chest- or breastfeeding. What's more, it's recommended.

"Breastfeeding (or pumping) is absolutely safe with mastitis and is encouraged," says Dr. Sublett. "What is critical is that you stay on your normal schedule for milk removal; breastfeeding or pumping more frequently will actually worsen the inflammatory process and worsen symptoms."

Can You Get Mastitis More Than Once?

While most people get mastitis once, some do end up dealing with recurrent cases of mastitis. Dr. Sublett says that risk factors for recurrent mastitis include oversupply, as well as factors that disrupt the milk microbiome like antibiotic use. "We see mastitis more commonly in exclusive pumpers, those with a history of bacterial mastitis, and [those who] use nipple shields," she says.

You should consider speaking to a health professional if you have recurrent mastitis and you've been unable to address it on your own. "If you get recurrent mastitis, a consultation with a certified lactation consultant can be helpful to identify any problems that are contributing to the development of mastitis," says Dr. Jordan.

What Are the Best Ways to Prevent Mastitis?

There are some simple things you can do to prevent mastitis from occurring in the first place, or from coming back, says Dr. Jordan. This includes making sure your baby is latching on well, staying well hydrated, and avoiding tight fitting bras. According to Dr. Sublett, you should also avoid any activities which may lead to an overproduction of milk, such as excessive pumping.

The ABM says that taking a supplement called lecithin may decrease inflammation in the breast. They recommend five to 10 grams a day of either sunflower or soy lecithin. You may also want to consider taking a probiotic supplement to balance out your microbiome, says Dr. Sublett.

Definitely touch base with a healthcare professional or lactation consultant if you have further questions about mastitis, and reach out as soon as possible if you are currently experiencing mastitis symptoms. You deserve to feel better, and to have a more comfortable breastfeeding experience.