Mastitis - What is it, how to avoid it and what helps?

Mastitis is an inflammation of the breast that most often occurs during breastfeeding. It can cause pain, swelling, local heat, and a hardened area, often accompanied by fatigue, body aches, chills, or fever. Symptoms usually appear rapidly and, in most cases, affect only one breast.

Although often associated with an infection, not all cases of mastitis are bacterial in origin. The condition often begins with inflammation of the breast tissue. Swelling around the milk ducts narrows them and slows the flow. The Academy of Breastfeeding Medicine places these situations on a spectrum that can progress from localized inflammation to bacterial mastitis or, less frequently, an abscess.

What can cause Mastitis?

Breast engorgement happens when the breasts become very full, tense, and uncomfortable, especially in the first days after childbirth. This condition is not the same thing as mastitis. However, when it is intense or persists for too long, it can promote breast inflammation and increase the risk of mastitis.

Sudden gaps between breastfeeding sessions, abrupt changes in routine, poor latching, pressure caused by tight clothing, or pumping more than the baby needs can contribute to the problem. Milk production adapts to the stimulation received. When milk is repeatedly extracted to empty the breast, the body may interpret this stimulus as a need to produce more, which can consequently cause discomfort.

There are also cases of mastitis outside the breastfeeding period. In such situations, medical evaluation is necessary, as there may be other causes (such as infection through broken skin, eczema, a nipple piercing, or changes in the breast tissue).

Usual symptoms

Usual symptoms consist of:
-Localized swelling;
-Local heat;
-Pain or tenderness to the touch;
-Hardened area or lump, sometimes wedge-shaped;
-Burning during or between breastfeeding sessions;
-Nipple tenderness;
-Small amount of discharge, occasionally with traces of blood;
-Redness, although it may be less visible on brown or black skin;
-Fever;
-Chills;
-Muscle aches;
-Intense fatigue;
-Flu-like feeling.

On brown or black skin, heat, pain, swelling, and changes in the consistency of the breast may be more evident signs than redness.

Care that usually helps in the first hours

Breastfeeding can continue on demand, without deliberately increasing the frequency of breastfeeding on the affected breast. Breast milk is generally still safe for the baby, even when there is an infection or when the mother needs an antibiotic compatible with breastfeeding. Stopping abruptly can increase milk accumulation and worsen discomfort.

When breastfeeding is too painful, the baby refuses that breast, or there is a temporary separation, you can manually express just enough milk to feed the baby or relieve tension. The goal is not to leave the breast completely empty. Excessive pumping, especially at high suction levels, can irritate the nipple and breast tissue.

Applying cold helps reduce swelling and pain. A cold compress wrapped in a cloth can be used for about ten minutes between breastfeeding sessions or at regular intervals. Ice should never be in direct contact with the skin. Gentle heat can be used for a few minutes before breastfeeding or pumping if it provides comfort and helps the milk flow. However, it does not treat mastitis and, when applied for too long, can worsen swelling and inflammation. To relieve pain and edema, cold is generally the most recommended option.

Rest, regular fluid intake, and a comfortable bra, with support without compression, can also relieve symptoms. Paracetamol or ibuprofen are frequently used to control pain and fever, provided there are no contraindications and the instructions of a doctor or pharmacist are followed.

Vigorous massage can worsen inflammation

The idea that it is necessary to squeeze the breast until a lump is broken down is still quite widespread, but intense pressure can damage the tissue and increase swelling. Examples to avoid include deep massages, vibrating devices, or painful movements over the hardened area.

When touching the breast, the pressure should be light. A delicate approach, without trying to forcibly push milk toward the nipple, better protects tissue that is already inflamed. It is also not advisable to apply oils, creams, salts, homemade preparations, or substances not intended for that purpose.

Prevention depends mainly on the breastfeeding routine

Not all episodes can be avoided, but some measures reduce the risk. Breastfeeding sessions should follow the baby's hunger and satiety cues as much as possible, without rigid schedules or long imposed intervals. When there is a need to reduce breastfeeding or begin weaning, the change should be gradual.

A comfortable latch and effective milk transfer deserve attention, especially when fissures, persistent pain, very prolonged breastfeeding sessions, or poor weight gain occur. Support from a nurse specialized in maternal health, a midwife, or a lactation consultant can help correct the position and determine if the baby is removing milk adequately.

Anyone using a breast pump should check if the flange size fits the nipple and if the suction intensity does not cause pain, swelling, or friction. Pumping should respond to a specific need, such as replacing a breastfeeding session, maintaining production during a separation, or relieving uncomfortable tension. Creating reserves much higher than the baby's needs can stimulate overproduction.

Very tight bras, straps that compress the breast, heavy backpacks, sleeping with prolonged pressure on the breast, or using poorly adjusted milk collection cups can also cause discomfort. Any accessory worn inside the bra should leave enough space and must not exert pressure on a specific area.

Breastfeeding support products

None of these products treat mastitis nor do they replace an evaluation by a healthcare professional. They can, however, help to protect the nipples, improve comfort, and facilitate milk management in specific situations.

Elvie Pump and Elvie Curve - allow you to express milk practically when the baby is unable to breastfeed or when breastfeeding does not happen. In case of engorgement or inflammation, expression should be limited to the amount necessary to relieve discomfort. Repeatedly emptying the breast can stimulate milk production beyond the baby's needs. Suction should be comfortable and never cause pain or changes to the nipple.

Elvie Catch - collects spontaneous milk leaks without resorting to active expression. This pair of reusable cups is placed inside the bra and can collect up to 30 ml on each side. It should be removed every two to three hours so that the nipple stays dry and without prolonged pressure.

Adapters and silicone cushions for Elvie Pump - improve the fit of the pump to the nipple size. A proper fit can make expression more comfortable, decrease friction, and favor more effective milk removal. Elvie cushions are available in various sizes and are intended to be placed inside the 24 mm breast shields.

Philips Avent breast shells and nipple protectors - offer different support depending on the difficulty. The shells help to protect sore or cracked nipples from contact with clothing and can also collect small milk leaks. Silicone protectors can temporarily facilitate latching when there are cracks, pain, or difficulties in the baby's adaptation. They should be the appropriate size and used with professional advice to confirm that the baby continues to remove milk effectively.

Barral MotherProtect Nipple Protective Cream - hydrates and protects dry, sensitive, or cracked skin. It does not prevent or directly treat mastitis, but it can help preserve the skin barrier and make breastfeeding more comfortable when there is cracking or irritation.

Doomoo Twisty 2-in-1 - offers support for mother and baby during breastfeeding. A comfortable position, with arms and shoulders relaxed and the baby well supported, can facilitate an effective latch. The relationship with mastitis is indirect, so this pillow should be viewed as a product for comfort and positioning, not as a form of treatment.

The right time to seek help

A medical evaluation is recommended when symptoms worsen, do not start to improve after 12 to 24 hours of home care, or appear in a person who is not breastfeeding. Help should also be sought in the presence of a persistent fever, intense malaise, difficult-to-control pain, discharge with pus, recurrent episodes, or a hardened area that increases.

Antibiotics are not necessary in all cases, but they may be prescribed when there is suspicion of bacterial mastitis or when the evolution is not favorable. If there is no improvement within the first 48 hours after starting the antibiotic, a new evaluation is required.

A well-defined, very painful, and persistent swelling may indicate the formation of an abscess. The diagnosis usually includes an ultrasound, and treatment may require draining the contents using a needle or a small incision. Even in these cases, breastfeeding can often continue, according to the guidance of the health team.

Taking care of your body today is investing in the well-being of tomorrow.— Aveimédica

Frequently Asked Questions

Is it necessary to empty the breast completely?

The breast does not need to be empty. Expressing more than the baby's needs can stimulate more production and prolong the problem. You should only express the amount necessary to maintain usual feedings or relieve uncomfortable tension.

Does a breast pump prevent mastitis?

The breast pump is useful when it replaces a breastfeeding session or when there is a specific need for expression. Excessive use, painful suction, or a breast shield that is the wrong size can irritate the tissue and promote milk production beyond what is necessary.

Can mastitis come back?

Recurrent episodes justify an evaluation of the latch, position, expression routine, and the possible existence of oversupply. It is also necessary to exclude other causes when inflammation appears repeatedly in the same spot.

Can mastitis turn into an abscess?

An infection that does not improve can, in some cases, lead to a localized accumulation of pus. A painful lump that persists or grows should be observed promptly, especially when there is a fever or worsening of general condition.

This content is for informational purposes and does not replace the evaluation of a doctor or the monitoring of a professional trained in breastfeeding.