Mastitis: what is it and what you can do as a breastfeeding mum

Being a new parent and feeding your baby can be a wonderful experience, but it can also come with its challenges. One common concern for breastfeeding individuals is mastitis, a term you might hear a lot. But what exactly is it? And is it always the same thing?

This article will help you understand the world of breast issues that can arise during lactation. We'll break down the different types of problems and discuss what you can do to feel better, drawing on the latest expert advice. Remember, this information is for general understanding, and it's always best to talk to your healthcare provider for personalized advice.

The Old Way of Thinking About Mastitis

In the past, mastitis was often thought of as a single condition – usually a bacterial infection in the breast. People might have told you it was caused by a blocked milk duct that got infected, or maybe due to poor hygiene. While bacteria can sometimes be involved, we now know that the picture is much more complex.

Introducing the Mastitis Spectrum

Think of mastitis as a spectrum of conditions, rather than just one single problem. This spectrum includes a range of issues caused by inflammation in the milk ducts and swelling in the surrounding breast tissue. Understanding this spectrum can help you recognize problems early and take appropriate steps. Here are some of the key players in this spectrum:

• Ductal Narrowing (Sometimes Called "Plugging"): You might have heard the term "milk plug." While it feels like a single duct is blocked, what's really happening is microscopic inflammation and narrowing of many tiny milk ducts. This can be due to the milk-producing parts of the breast (alveoli) being too full or an imbalance in the natural bacteria in your breast milk (more on that later). You might feel a tender spot or general congestion in your breast, sometimes with mild redness. It's important to know that trying to aggressively squeeze out a "plug" can actually cause more harm.

• Inflammatory Mastitis: If the ductal narrowing persists or gets worse, the surrounding inflammation can increase, leading to inflammatory mastitis. This is when a larger area of your breast becomes redder, swollen, and more painful. You might also start feeling systemic symptoms like fever, chills, and a faster heartbeat, even without a bacterial infection.

• Bacterial Mastitis: This is when a bacterial infection develops on top of the inflammation. Common bacteria involved are types of Staphylococcus and Streptococcus. Despite what you might have heard, bacterial mastitis is not contagious to your baby and doesn't mean you need to stop breastfeeding. It's also not usually caused by poor hygiene, so you don't need to sterilize everything obsessively. Symptoms of bacterial mastitis include worsening redness and firmness in a specific area of the breast, which might spread. Your healthcare provider might consider antibiotics or probiotics to help resolve this.

• Phlegmon: In some cases, especially if there has been aggressive deep tissue massage, a phlegmon can develop. This is a firm, mass-like area without a clear collection of fluid. It's a complex fluid collection caused by inflammation deep in the tissue.

• Abscess: An abscess is a collection of infected fluid that can develop as a progression from bacterial mastitis or a phlegmon. You might feel a firm, red, and often very tender area with a palpable lump that feels like it contains fluid. Sometimes the initial fever might go away only to return. Abscesses usually require drainage by a healthcare professional.

• Galactocele and Infected Galactocele: A galactocele is a cyst-like cavity filled with milk that can form when a milk duct gets significantly narrowed. It feels like a moderately firm mass that can change in size. It's usually not very painful and doesn't have redness or systemic symptoms unless it becomes infected. An infected galactocele will then require drainage and antibiotics.

• Subacute Mastitis: This type of mastitis occurs due to a long-term imbalance in the breast milk bacteria, leading to the formation of bacterial biofilms that narrow the milk ducts. You might experience burning, needle-like breast pain, nipple blebs (more on those below), and recurring areas of hardness. Systemic symptoms are less common with subacute mastitis.

• Recurrent Mastitis: This is when you experience mastitis symptoms repeatedly. It can be due to ongoing issues like oversupply, imbalances in breast milk bacteria, or not fully addressing the cause of previous episodes.

• Early Postpartum Engorgement: While not part of the mastitis spectrum, early breast engorgement that happens a few days after birth as your milk comes in can have some similar symptoms like pain and swelling. However, this is a normal process related to fluid shifts and increased blood flow. If managed well, it shouldn't lead to mastitis.

  
  

What Can Cause These Breast Issues?

Several factors can contribute to problems along the mastitis spectrum:

• Hyperlactation (Oversupply): Producing more milk than your baby needs can lead to the alveoli (milk-producing sacs) becoming overly full, causing inflammation and ductal narrowing.

• Mammary Dysbiosis (Imbalance in Breast Milk Bacteria): The community of bacteria in breast milk plays a role in health. Factors like genetics, antibiotics, probiotics, pumping, and Cesarean birth can affect this balance, potentially leading to inflammation and ductal narrowing.

• Inflammation: Inflammation itself can narrow the ducts and contribute to further problems.

• Tissue Trauma: Aggressive breast massage can actually worsen swelling and cause tiny injuries, potentially leading to phlegmon or abscess. Improper breast pump flange size or suction can also cause trauma.

• Nipple Blebs: These are like tiny blisters or white spots on your nipple, sometimes called "milk blisters". They are caused by inflammatory cells blocking the duct opening. We learned that you shouldn't try to pick at them, but things like oral lecithin and a mild topical steroid cream (with your doctor's advice and wiped off before feeding) might help.

• Things That Are NOT Usually the Cause: It's important to know that specific foods haven't been proven to cause mastitis, although your overall health and microbiome can be reflected in your diet. Also, as mentioned before, poor hygiene is not a primary cause of bacterial mastitis.

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What Can You Do To Feel Better? Spectrum-Wide Strategies

Many breast issues will resolve with simple, conservative care and support. Here's what you can try:

• Reassurance and Rest: Know that many symptoms will get better with gentle care. Try to decrease stress and get more rest.

• Understand Your Breasts: Remember that lactating breasts can feel lumpy and sometimes painful – this isn't always a sign of a problem. Hormonal changes can also cause symptoms like sweating that might feel like a fever.

• Feed Your Baby On Demand: Let your baby guide feedings and don't try to "empty" your breasts completelywith each feed. Milk production works on a feedback system – the more you remove, the more you make. Overfeeding from the affected side or excessive pumping can worsen inflammation and oversupply. You can hand-express a small amount for comfort if needed.

• Be Mindful of Pumping: Breast pumps are helpful when you're separated from your baby, but they don't remove milk as physiologically as your baby does and might contribute to bacterial imbalances. Use the pump only when needed and try to mimic your baby's feeding frequency and volume.

• Avoid Nipple Shields: There's not good evidence to support their use, and they can interfere with effective milk removal.

• Wear a Supportive Bra: This can help with comfort and lymphatic drainage.

• Gentle Touch is Key: Avoid deep, aggressive massage as it can increase inflammation and cause tissue damage. Gentle, light strokes towards your lymph nodes (under your armpit) might be helpful for lymphatic drainage.

• Forget Topical "Cures": Saline soaks, castor oil, and other topical products are unlikely to treat deep inflammation or infection and might even cause skin irritation.

• Normal Cleaning is Enough: Clean your pump parts appropriately after each use, but routine sterilization of everything isn't necessary. Avoid over-cleaning your nipples.

• Cool Relief: Applying ice packs can help reduce swelling and pain. You can do this frequently but not right before a feed (preferrably after a feed).

• Pain Relief: Over-the-counter pain relievers like ibuprofen (following recommended dosage) and acetaminophen/paracetamol can help with pain and inflammation.

• Consider Lecithin: Some people find that sunflower or soy lecithin (5-10 grams daily) helps to reduce inflammation in the ducts and make milk less sticky.

• Address Nipple Blebs: If you have a nipple bleb, avoid picking at it. Oral lecithin and a topical mild steroid cream (with your doctor's guidance) might help reduce inflammation. Remember to wipe off any cream before feeding..

• Probiotics: L. Bacillus and L. Salivarius have been scientifically researched and may help support/restore a good microbiome which can help you heal & prevent mastitis.

• Therapeutic Ultrasound: In some cases, a trained professional might use therapeutic ultrasound to help reduce inflammation and swelling.

  
  

When Might You Need More Help?

While many issues resolve with the self-care strategies above, there are times when you should seek medical advice:

• Signs of Bacterial Mastitis: If you have persistent systemic symptoms like fever and a rapid heartbeat for more than 24 hours, or if your breast redness and firmness are worsening despite conservative measures, your healthcare provider might consider antibiotics.

• No Improvement: If your symptoms don't improve after 48 hours of trying conservative measures.

• Suspicion of Abscess: If you feel a distinct, painful lump that feels like it contains fluid.

• Recurrent Problems: If you keep experiencing mastitis symptoms.

• Concerns About Your Health: If you have any other worries about your breast health.

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Your doctor might consider a milk culture to identify specific bacteria if antibiotics are needed, especially if there's no improvement with initial treatment or if you have recurrent infections.

For an abscess or a symptomatic galactocele, drainage by needle aspiration or drain placement is often recommended. It's usually safe to continue breastfeeding from the affected breast after drainage.

If you experience recurrent mastitis in the same location, your doctor might recommend imaging to rule out any underlying issues.

Important Reminders

• Breastfeeding is Usually Safe: In most cases of mastitis, it is safe for your baby to continue feeding from the affected breast.

• Antibiotics Aren't Always the Answer: Using antibiotics unnecessarily can disrupt the healthy bacteria in your breast milk and contribute to antibiotic resistance.

• Take Care of Your Mental Health: Breastfeeding challenges can be stressful. Women with a history of anxiety and depression might be more likely to experience mastitis symptoms, and any breastfeeding complications can increase the risk of postpartum mood and anxiety disorders. Don't hesitate to reach out for support if you're feeling overwhelmed.

• Gentle and Physiological is Best: The traditional advice to aggressively massage your breasts and pump frequently to empty them is now understood to often worsen the problem. Gentle approaches that respect your body's natural feedback mechanisms are

  more effective.

In Conclusion

Understanding that breast issues during lactation exist on a spectrum and have various underlying causes empowers you to take informed steps towards feeling better. By focusing on gentle, physiological approaches and seeking professional help when needed, you can navigate these challenges and continue your breastfeeding journey comfortably. Remember, you're not alone, and support is available.

Disclaimer: This blog article provides general information and should not be considered medical advice. Always consult with your healthcare provider for diagnosis and treatment of any medical condition.

If you have any questions about this topic or need some guidance from one of our lactation consultants, you can make an appointment with us.

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