Topic Overview
What is mastitis?
Mastitis is a breast inflammation usually caused by
			 infection. It can happen to any woman, although mastitis is most common during
			 the first 6 months of
			 breastfeeding. It can leave a new mother feeling very
			 tired and run-down. Add the illness to the demands of taking care of a newborn,
			 and many women quit breastfeeding altogether. But you can continue to nurse
			 your baby. In fact, breastfeeding usually helps to clear up infection, and
			 nursing will not harm your baby.
Although mastitis can be discouraging and painful, it is usually easily
			 cleared up with medicine.
What causes mastitis?
 Mastitis most often happens
			 when bacteria enter the breast through the nipple.
			 This can happen when a nursing mother has a cracked or sore nipple.
 Going for long stretches between nursing or failing to empty the breast
			 completely may also contribute to mastitis. Using different
			 breastfeeding techniques and making sure your baby is
			 latched on properly when nursing will help with emptying the breast and avoiding
			 cracked nipples. 
			 View a slideshow on latching to learn how to get your baby to latch on.
What are the symptoms?
Mastitis usually starts as
			 a painful area in one breast. It may be red or warm to the touch, or both. You
			 may also have fever, chills, and body aches.
Signs that mastitis
			 is getting worse include swollen, painful
			 lymph nodes in the armpit next to the infected breast,
			 a fast heart rate, and flu-like symptoms that get worse. Mastitis can lead to a
			 breast
			 abscess, which feels like a hard, painful lump.
			 
What increases your risk of getting mastitis?
You
			 are more likely to get mastitis while breastfeeding if:
- You have had mastitis before.
- You delay or skip breastfeeding or pumping
				sessions. When you don't empty the breast regularly or completely, your breasts
				become
				engorged or too full, which can lead to mastitis.
				
- You have cracked or irritated nipples, which can be caused by poor
				positioning or poor latching on. 
- You have
				anemia. Anemia makes you tire more easily and lowers
				your resistance to infections like mastitis.
Breastfeeding mothers can get mastitis at any time, but
			 especially during the baby's first 2 months. After 2 months, the baby's feeding
			 patterns become more regular, which helps prevent mastitis. 
How is mastitis diagnosed?
Your doctor can tell
			 whether you have mastitis by talking with you about your symptoms and examining you. Testing is usually not needed. 
How is it treated?
Antibiotics can
			 usually cure mastitis. If your doctor prescribes antibiotics, take them as
			 directed. Do not stop taking them just because you feel better. You need to
			 take the full course of pills. The antibiotics will not harm the baby. If
			 treatment doesn't work at first, your doctor may send a sample of your breast
			 milk to a lab to help identify the type of bacteria causing the infection.
			 
 You can help yourself feel better by getting more rest, drinking
			 more fluids, and using warm or cold packs on your painful breast. 
Before breastfeeding your baby, place a warm, wet washcloth over the
			 affected breast for about 15 minutes. Try this at least 3 times a day. This
			 increases milk flow in the breast. Massaging the affected breast may also
			 increase milk flow.
You can safely take acetaminophen (such as
			 Tylenol) for pain or a fever. You can take ibuprofen (such as Advil) along with
			 acetaminophen to reduce inflammation. Be safe with medicines. Read and follow all instructions on the label.
Breastfeeding from your
			 affected breast is safe for your baby. If starting with the affected breast is too painful, try feeding your baby with your healthy breast first. Then, after your milk is flowing, breastfeed from the affected breast. If your nipples are too cracked and painful to
			 breastfeed from that breast, hand express or use a breast pump to empty the breast of milk.
			 Try this each time that you cannot breastfeed.
This is a good time
			 to consider getting help from a
			 lactation consultant. This person-usually a
			 nurse-specializes in helping women with breastfeeding. You can breastfeed
			 more effectively with less pain and help prevent future mastitis if you
			 remember to change positions and make sure that your baby is latching on
			 properly. 
Be sure to get treatment for mastitis. Delaying
			 treatment can lead to a breast abscess, which can be harder to treat.
Frequently Asked Questions
| Learning about mastitis: |  | 
| Being diagnosed: |  | 
| Getting treatment: |  | 
Symptoms
The symptoms of
		  mastitis most often appear within 4 to 6 weeks after
		  childbirth.
 If you have
		  mastitis, you may first notice:
- A painful area on one breast. It may be
			 reddened, warm to the touch, or both.
- Chills, aches, and flu-like
			 symptoms.
- A fever.
These initial symptoms may start after you have resolved a
		  blocked milk duct.
When to call
Call your doctor now if you
		have:
- Increasing pain in one area of the
		  breast.
- Increasing redness in one area of the breast or red streaks
		  extending away from an area of the breast.
- Drainage of pus from the
		  nipple or another area of the breast.
- A fever of 101°F (38.5°C) or
		  higher.
Call your doctor today if you
		have:
- Swollen glands (lymph nodes) in
		  the neck or armpit.
- A fever less than 101°F (38.5°C).
Call your doctor if you have other breast problems like cracked and bleeding nipples or blisters on your nipples that are not relieved by home treatment.
Breast abscess
In some cases, symptoms of mastitis
			 get worse and the breast develops a pocket of pus (abscess) in the
			 infected area. Symptoms of a breast abscess include:
- A breast lump that is hard and
				painful.
- A reddened area on the breast.
- Flu-like
				symptoms that are getting worse.
Thrush infection
Thrush (yeast infection) can occur in your baby's
			 mouth and spread to your nipples and breast ducts. If you have symptoms of
			 mastitis that are not going away in spite of treatment, pain in the nipple area
			 during and after breastfeeding, sharp breast pain in between feedings, or
			 nipples that look very pink, you may have a yeast infection. This condition can also begin
			 with a sudden start of pain or burning when breastfeeding has been going well
			 without problems.
If you have yeast infection symptoms, both your nipples
			 and your baby's mouth should be checked for thrush. Treatment for thrush
			 requires that both you and your baby be treated, even if your baby doesn't have
			 symptoms. For more information, see the topic
			 Thrush.
Exams and Tests
Your doctor can usually diagnose
		  mastitis based on your symptoms and an examination of
		  the affected breast. Tests are usually not needed. But
		  they may be done to confirm a diagnosis or to help guide treatment for other
		  problems that can develop. 
Breast milk culture
If you have an infection that
			 isn't improving with treatment, your doctor may do a breast milk
			 culture. To provide a sample for a culture, you will
			 squeeze a small sample of milk from the affected breast onto a sterile swab.
			 The culture results help your doctor confirm a diagnosis and to find out the
			 specific bacteria that are causing the infection.
In some cases, it
			 takes more than one round of antibiotics to clear a breast infection. If you
			 have not been responding to antibiotic treatment, culture results may be used
			 to find out the most effective antibiotic for you.
Abscess
Sometimes a pocket of pus (abscess) forms
			 in the reddened area of the breast. If an abscess is too deep to examine by
			 touching it, your doctor may use a
			 breast ultrasound to examine it. Ultrasound can also
			 be used to guide a needle to an abscess that needs to be drained of fluid. A
			 culture of the abscess fluid is usually done to identify the infecting
			 organism.
Treatment Overview
Mastitis will
		  not go away without treatment. If you have
		  mastitis symptoms, you may need to call your doctor
		  today. Prompt treatment helps keep infection from rapidly getting worse and
		  usually improves symptoms after about 2 days. 
Mastitis treatment
Treatment for
			 mastitis usually includes: 
- Oral
				antibiotics to destroy the bacteria causing the
				infection. 
- Regularly emptying the breast well by breastfeeding or
				pumping breast milk. Adequate emptying of the affected breast helps prevent
				more bacteria from collecting in the breast and may shorten the duration of the
				infection.
You can safely continue breastfeeding your baby or
			 pumping breast milk to feed your baby during illness and treatment. Your baby is the most efficient pump you have for emptying
			 your breasts. Your breast milk is safe for your baby to drink, because any
			 bacteria in your milk will be destroyed by the baby's digestive juices. 
- Before breastfeeding your baby, place a
				warm, wet washcloth over the affected breast for about 15 minutes. Try this at
				least 3 times a day. This increases milk flow in the breast. Massaging the
				affected breast may also increase milk flow.
- If possible, continue breastfeeding on both sides. Ideally,
				start on the affected side-it's critical that you empty this breast thoroughly. If starting with the affected breast is too painful, try feeding your baby with your healthy breast first. Then, after your milk is flowing, breastfeed from the affected
				breast until it feels soft. Switch back to the healthy breast and breastfeed
				until your baby has finished.
- Pump or express milk from the
				affected breast if pain prevents you from breastfeeding. Nipple pain can be
				caused by the baby latching on to sore nipples. For more information on pumping
				or expressing breast milk, see the topic
				Breastfeeding.
-  Your baby may seem
				reluctant to nurse on your painful breast. This is not because your milk tastes
				strange, but more likely because your breast feels different and it is harder
				for your baby to nurse. Try expressing a little milk first. This will soften
				the breast and make it easier for your baby to latch on.
Breast abscess treatment
If you have mastitis
			 because of a blocked duct and you delay treatment, your breast infection may
			 develop into an
			 abscess. Treatment for an abscess includes: 
- Draining the abscess. Abscess healing
				can take 5 to 7 days.
- Oral
				antibiotic treatment to destroy the bacteria causing
				the infection. (Antibiotics are given
				intravenously only in rare cases of severe
				infection.)
- Emptying the breast well and regularly by breastfeeding or
				pumping, which is essential to keeping a good milk supply. 
Most women can continue breastfeeding on the affected
			 breast while an abscess heals. With your doctor's approval, you can cover the
			 abscess area with a light gauze dressing while breastfeeding.
If
			 you are advised to stop breastfeeding from the affected breast while an
			 abscess heals, you can continue breastfeeding from the healthy breast. Be sure
			 to pump or express milk from the infected breast regularly. 
For
			 more information on pumping or expressing breast milk, see the topic
			 Breastfeeding.
Home Treatment
 From the time you begin breastfeeding
		  until your baby is weaned, take measures to
		  prevent mastitis. For example, learn about
		  different breastfeeding techniques so that you will
		  know how to completely empty your breasts. Not emptying your breasts completely
		  when nursing or going too long between feedings may lead to mastitis. View a slideshow on latching to learn how to get your baby to latch on.
If you have
		  symptoms of mastitis, you may need to call your doctor
		  right away. Delaying treatment can lead to an
		  abscess forming in the affected breast. Severe
		  infection can require
		  intravenous antibiotics in the hospital.
Breastfeeding with mastitis
 Along with oral
			 antibiotic treatment, continuing to nurse your baby and being careful to empty
			 your breasts completely will help shorten the duration of the infection.
			 
You can safely continue breastfeeding your baby or pumping
			 breast milk to feed your baby during illness and treatment. Your baby is the most efficient pump you have for emptying
			 your breasts. Your breast milk is safe for your baby to drink, because any
			 bacteria in your milk will be destroyed by the baby's digestive juices. 
- Before breastfeeding your baby, place a
				warm, wet washcloth over the affected breast for about 15 minutes. Try this at
				least 3 times a day. This increases milk flow in the breast. Massaging the
				affected breast may also increase milk flow.
- If possible, continue breastfeeding on both sides. Ideally,
				start on the affected side-it's critical that you empty this breast thoroughly.
				If starting with the affected breast is too painful, try feeding your baby with your healthy breast first. Then, after your milk is flowing, breastfeed from the affected
				breast until it feels soft. Switch back to the healthy breast and breastfeed
				until your baby has finished.
- Pump or express milk from the
				affected breast if pain prevents you from breastfeeding. Nipple pain can be
				caused by the baby latching on to sore nipples. For more information on pumping
				or expressing breast milk, see the topic
				Breastfeeding.
-  A lanolin-based cream,
				such as Lansinoh, may help heal sore or cracked nipples.
-  If you
				use nursing pads, replace them frequently so they are dry and clean. 
Self-care measures for mastitis
In addition to
			 taking your prescribed antibiotics and continuing to breastfeed or pump breast
			 milk, there are other steps you can take to make yourself feel better until the
			 mastitis goes away.
- Take
				acetaminophen (such as Tylenol) to relieve your pain, fever,
				or discomfort. You can take
				ibuprofen (such as Advil) along with acetaminophen to
				reduce inflammation if needed. Be safe with medicines. Read and follow all instructions on the label.
- Rest as much as
				possible.
-  Apply an ice pack or a warm compress to the affected
				breast to help reduce your pain. If you use an ice pack, place the ice outside
				of your bra or clothing. Do not put the ice directly on your bare
				skin.
- Drink extra fluids.
- If your breasts are very full
				(engorged), pump or express a small amount of breast
				milk before breastfeeding. This will make your breasts less full and may make
				it easier for your baby to latch on to your breast.
- If pus is
				draining from your infected breast, wash the nipple gently and let it air dry
				before putting your bra back on. A disposable breast pad placed in the bra cup
				may absorb the drainage.
Most women can successfully continue breastfeeding
		  during a breast infection. If mastitis makes it difficult for you to continue
		  breastfeeding while the infection is being treated, remember that emptying
		  your breasts regularly is essential. Don't hesitate to talk to your doctor or a
		  lactation consultant for further help and
		  support.
Other Places To Get Help
Organization
American Academy of Family
		Physicians: FamilyDoctor.org
www.familydoctor.org
References
Other Works Consulted
- Betzold CM (2007). An update on the recognition and management of lactational breast inflammation. Journal of Midwifery and Women's Health, 52(6): 595-605.
- Dixon JM, Bundred NJ (2010). Management of disorders of the ductal system and infections. In JR Harris et al., eds., Diseases of the Breast, 4th ed., pp. 42-51. Philadelphia: Lippincott Williams and Wilkins.
- Lawrence RM, Lawrence RA (2009). The breast and physiology of lactation. In RK Creasy et al., eds., Creasy and Resnik's Maternal-Fetal Medicine, 6th ed., pp. 125-142. Philadelphia: Saunders Elsevier.
- Poggi SBH (2013). Postpartum hemorrhage and the abnormal puerperium. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 11th ed., pp. 349-368. New York: McGraw-Hill.
Credits
ByHealthwise Staff
Primary Medical ReviewerSarah Marshall, MD - Family Medicine
Specialist Medical ReviewerKirtly Jones, MD - Obstetrics and Gynecology
Current as ofMarch 16, 2017