Mastitis
Mastitis is inflammation of the breast tissue. It is met most often by women in the first months of breastfeeding: an area of the breast turns firm, hot and…
On this page
- Telling it apart from a blocked breast
- Why it starts
- What to do in the first day
- When you need a doctor and when an ambulance
- What the doctor does: examination and tests
- Antibiotics and breastfeeding
- If an abscess forms
- Mastitis outside breastfeeding and in men
- Reducing the chance of it coming back
- Online consultation with a doctor
Medicines commonly prescribed for Mastitis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 500/125 mg/mgActive substance: amoxicillin and beta-lactamase inhibitorManufacturer: Viatris LimitedPrescription requiredDosage form: TABLET, 875/125 mg/mgActive substance: amoxicillin and beta-lactamase inhibitorManufacturer: Aurovitas Spain, S.A.U.Prescription requiredDosage form: TABLET, 875 mg + 125 mgActive substance: amoxicillin and beta-lactamase inhibitorManufacturer: Laboratorio Stada S.L.Prescription required
Mastitis is inflammation of the breast tissue. It is met most often by women in the first months of breastfeeding: an area of the breast turns firm, hot and painful, and shivering and fever follow quickly. Less commonly it affects women who are not breastfeeding, and men. It starts abruptly — a person can feel perfectly well in the morning and by the evening have severe breast pain and a high temperature — and it is that speed that frightens people most. Most cases settle within a few days if the first twenty-four hours are handled well and the moment to see a doctor is recognised in time.
Telling it apart from a blocked breast
Mastitis almost always starts with milk that is not moving. When milk stops leaving part of the gland freely, pressure in the ducts rises, some of the contents seep into the surrounding tissue and the body answers with inflammation. Infection is not required: there can be inflammation without any bacteria.
With simple blockage the breast is full and tender, but you feel reasonably well in yourself, and a feed or an expression brings clear relief. Mastitis behaves differently:
- as a rule only one breast is affected, and not all of it but an area that is firm, hot and painful to touch;
- the skin over it reddens; on brown and black skin the redness is harder to see, so go by the heat and the pain;
- the pain is burning or shooting and often worsens as the milk lets down;
- a temperature comes on with shivering and aching all over, much like flu;
- a feed does bring relief, but only partial and short-lived.
Sometimes there is discharge from the nipple, white or streaked with blood. On its own it is not a disaster, but it is worth mentioning to a doctor.
Why it starts
In a breastfeeding woman the problem is usually milk stagnating somewhere. That follows from a poor latch, which leaves the gland incompletely drained; from long gaps between feeds, a skipped night feed or an abrupt switch to formula; and from pressure on the breast, whether a tight bra, a bag strap or sleeping face down. Producing far more milk than the baby takes is enough on its own to keep the ducts overfilled.
The second route runs through a damaged nipple. Cracks from a poor latch, eczema or a piercing give bacteria a way into the breast tissue.
Outside breastfeeding mastitis works differently. Smoking comes first here: substances in tobacco smoke damage the wall of the ducts behind the nipple, and chronic inflammation settles in them. Diabetes and other conditions that weaken defence against infection also count, as do injury to the breast, having an implant and, occasionally, rare inflammatory diseases of the gland itself.
What to do in the first day
The main rule is simple: the breast must go on draining, but without being forced.
- Feed as usual, on demand, and start on the sore side while the baby sucks most strongly. Milk from the inflamed breast is safe for the baby.
- Before a feed you can hold a warm damp cloth against the breast for a short while or stand under a warm shower; that helps the milk flow. Do not apply strong heat for long, as warmth increases swelling.
- Between feeds use something cold: it eases pain and swelling better than heat does.
- Painkillers are allowed and worth taking. Paracetamol and ibuprofen are compatible with breastfeeding, and ibuprofen also reduces the inflammation. Aspirin is not suitable while breastfeeding.
- Rest and drink as much as you want. Lying down with the baby beside you is more useful than heroically getting through the housework.
What not to do: knead the lump hard, work it loose until you bruise, or express more than your usual volume hoping to empty the breast, all of which only add to the swelling and drive milk production up. Do not rub in oils, ointments or warming compresses. Avoid tight underwear until things improve. And do not stop breastfeeding suddenly: an abrupt halt makes matters worse almost every time.
When you need a doctor and when an ambulance
See a doctor the same day if:
- a day of home measures has brought no improvement, or things are worse;
- the temperature has lasted more than twenty-four hours;
- you have a cracked nipple with pus;
- the lump is growing and the skin over it has turned purple or shiny;
- you have been taking antibiotics for two days without improvement;
- mastitis has appeared in a woman who is not breastfeeding, or in a man — those cases always need examining.
Call an ambulance straight away if the inflammation shows signs of blood poisoning: a temperature above thirty-nine degrees with hard shivering, confusion or marked drowsiness, fast breathing, a fast pulse with low blood pressure, weakness so severe that standing is hard, very pale or mottled skin, cold hands and feet, or a sharp drop in the amount of urine. In Spain, Italy, Portugal, Poland and Ukraine an ambulance is called on the single European number 112; elsewhere use your national emergency number.
What the doctor does: examination and tests
The doctor looks at and feels both breasts, checks the glands in the armpit, assesses the nipple and watches how the baby latches. That is often enough for the diagnosis.
An ultrasound scan is arranged when the question is whether an abscess has formed: a collection of fluid inside the lump shows up well on ultrasound. Culturing the milk or the discharge makes sense in repeated mastitis, in severe illness and when the usual antibiotics are not working, because it shows which organism is there and what will treat it.
There is also a separate and very important task: not to miss inflammatory breast cancer. It looks much like mastitis, with redness, swelling and skin like orange peel, but it does not cause a high temperature and does not respond to antibiotics. Hence a firm rule: redness and firmness that have not fully cleared after a course of treatment call for a mammogram or an ultrasound scan and, where there is doubt, a biopsy. The same applies to any mastitis in a woman who is not breastfeeding. This does not mean you have cancer; it means the check must be done.
Antibiotics and breastfeeding
Not everyone needs antibiotics. If the inflammation came purely from blocked milk and is settling after a day of doing the right things, they are not required. They are prescribed when there is no improvement, when the illness is severe from the outset, or when there is a damaged nipple with clear infection. The drugs chosen work against staphylococcus — usually penicillins protected against bacterial enzymes, or cephalosporins; if you are allergic, an alternative is found.
Finish the course even if by the third day everything seems to have passed: half-treated mastitis comes back readily and ends in an abscess more often.
There is no need to stop feeding while taking antibiotics. The medicines used for mastitis are compatible with breastfeeding and only traces reach the milk. Occasionally the baby becomes more unsettled or the nappies looser, which passes once the course ends. If you are told to switch the baby to formula for the duration, ask why: usually there is no need, and a break in feeding worsens mastitis in its own right.
If an abscess forms
An abscess is a walled-off cavity of pus inside the gland, and it complicates roughly one case of mastitis in ten, most often when treatment started late. Suspect it when the temperature will not settle despite antibiotics, when the lump has become rounded and feels filled with fluid, when the skin over it has thinned and looks glossy, and when the pain throbs.
An abscess is not treated with a cut in the first instance but by ultrasound-guided aspiration: the doctor passes a needle in and draws the pus out, repeating it a few times if necessary. It is done under local anaesthetic and leaves almost no mark. An incision with a drain is needed only for a large abscess or one with several chambers. You can feed from the healthy breast throughout and usually from the affected one too, unless an incision crosses the areola; the doctor decides that.
Mastitis outside breastfeeding and in men
This kind of mastitis is considerably less common and almost always calls for a more careful work-up. Its commonest form is inflammation of the ducts behind the nipple in middle-aged women who smoke: it causes tenderness at the edge of the areola, thick nipple discharge, sometimes a drawn-in nipple, and a tendency to recur and to form fistulas. Treatment here begins with stopping smoking; without that the inflammation returns again and again.
Less often there is granulomatous mastitis, a rare inflammation of unknown cause that forms firm nodules and is treated quite differently. In men, inflammation of the breast follows injury, damage to the skin of the nipple, or diabetes. In all these cases, alongside treatment, an assessment is needed to rule out a tumour.
Reducing the chance of it coming back
If the mastitis was linked to breastfeeding, sort out the latch first of all: it is the commonest reason for a repeat. A breastfeeding counsellor, a midwife or a nurse can watch how the baby takes the breast and correct the position, and often that alone is enough.
Beyond that: avoid long gaps and do not skip feeds, change position at the breast so the gland drains evenly, and give up tight underwear and bags with a narrow strap across the shoulder. Wind breastfeeding down gradually, dropping one feed every few days. Treat cracked nipples at once rather than putting up with them. And stop smoking if the mastitis is not related to feeding — that is the single measure that genuinely changes the course of things.
Online consultation with a doctor
An online appointment suits the first day well, when it is unclear what is happening and whether you need to go anywhere. The doctor will ask how it began, help separate a blockage from mastitis, and explain what to do today and which signs decide tomorrow whether an antibiotic is needed. The appointment is a good place to go through the feeding pattern and the usual latch mistakes, to discuss which painkillers suit you, and to leave with a clear list of reasons not to wait until morning. Upload a photograph of the breast taken in good light beforehand, along with any test results. With signs of blood poisoning or a rapidly growing abscess an online appointment is not the right route: that needs care in person.
This material is for information only and does not replace medical advice.
Consult with a doctor about Mastitis
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Mastitis
Discuss your symptoms and possible next steps for Mastitis with a doctor online.
