Signs of mastitis – and what it looks like

mastitis

Mastitis is painful inflammation of breast tissue that can progress to a bacterial infection. Mastitis symptoms include a warm, red, painful lump in the breast and a burning sensation when nursing. If it progresses, you may have flu-like symptoms, such as fever and muscle aches. If you have early signs of mastitis, talk to your doctor or a lactation consultant. Get plenty of rest and continue to breastfeed, but don’t nurse more than necessary to feed your baby. You’ll need an antibiotic if you develop an infection.

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What is mastitis?

Mastitis is a painful inflammation of breast tissue. It happens to 2 to 10 percent of breastfeeding women, most often during the first three months of nursing. But you can develop mastitis anytime – including after you wean your child.

The Academy of Breastfeeding Medicine (ABM) defines mastitis as a spectrum disorder, meaning that there’s a progression of symptoms that you may experience, from inflammation with no infection to a bacterial infection.

It begins with the inflammation and narrowing of milk ducts and swelling of breast tissue. The situation may be worsened by an overproduction of milk, which further narrows the milk ducts. At this point, the condition is called inflammatory mastitis.

If the inflammation isn’t successfully addressed, an infection can develop. You may also develop an abscess (a collection of infected fluid, or pus) and/or a galactocele (a milk-filled cyst). These usually need to be drained through needle aspiration or surgery.

What causes mastitis?

Many factors can contribute to the development of mastitis. It tends to start when the breasts don’t drain and stay engorged. As the breast swells, the milk ducts become further compressed, and the milk becomes stagnant. If the milk doesn’t drain within 12 to 24 hours, bacteria may grow, resulting in bacterial mastitis. (If engorgement is managed properly, though, it shouldn’t progress to mastitis.)

  • Breastfeeding problems such as nipple trauma, blocked ducts, and latching difficulties
  • Hyperlactation (an overproduction of milk)
  • Weakened immune system. If you’re overly tired or stressed, or not eating well, you may be more susceptible to developing mastitis while breastfeeding.
  • A change in your breastfeeding schedule caused by issues such as teething, a cold, starting solid foods, sleeping through the night, or rapid weaning.
  • Pressure. Wearing a too-tight bra or placing other pressure on your breast (from the straps of a purse or backpack, for example) can restrict milk flow.

Mastitis can range in severity from a red and warm irritation to a flu-like infection. Hear what five moms have to say about their experience with mastitis.

Signs and symptoms of mastitis

Mastitis usually only affects one breast at a time, and the signs and symptoms can come on gradually or suddenly.

Early signs of mastitis may include a tender, hard lump in the breast. Keep in mind that breastfeeding breasts can feel lumpy normally, however.

Signs and symptoms of mastitis include:

  • A warm, red lump in the breast
  • Pain in the affected area
  • Burning sensation when nursing (that’s different than the normal, tingling letdown sensation)
  • Reduced milk production (but not always)

If your mastitis develops into an infection, you’ll also probably have:

  • Chills, fever of 101 degrees Fahrenheit or higher
  • Fatigue
  • Muscle aches
  • Red patches or streaks on your breast

Bacterial mastitis makes some women feel very ill – you may feel like you’ve come down with the flu. It can be overwhelming to feel so sick when you’re caring for a baby. With treatment, though, you should feel better in a few days.

What does mastitis look like?

If you have mastitis, your breast will look swollen, and the skin will probably be red. It may be a burning, bright red that covers the inflamed area or a splotchy, light red that resembles a rash. This mastitis rash should fade away as you treat the mastitis. (If you have dark skin, the redness may be harder to detect.)

You may also see a wedge- or crescent-shaped lump or hard area.

Note: The following picture shows a naked breast with mastitis and may be NSFW.

naked breast with mastitis

What should I do if I have mastitis symptoms?

Talk with your doctor or a lactation consultant if you develop signs of mastitis. Addressing it early on can help prevent it from worsening.

If you don’t have an infection, they may recommend that you start with home treatment, which is often effective for noninfectious mastitis. The goals are to relieve pain, reduce inflammation, maintain milk flow, and avoid infection.

To treat mastitis symptoms at home:

  • Rest. Leave the dirty dishes in the sink, have someone else do the laundry, and limit visitors. Ask family and friends to help so you can rest fully and recover.
  • Continue to breastfeed as usual. Women with mastitis were previously advised to nurse or pump often, to empty their breasts at each session, and to start nursing on the affected breast. More recent guidance from the ABM suggests a better way to manage your milk production while you have mastitis: Try not to increase or decrease the number of feedings right now. Feed your baby until they’re full (no need to empty your breasts). You don’t want to produce more milk, but you want to keep your milk production going. Begin nursing with the non-affected breast, to avoid stimulating more milk production in the breast with mastitis.
  • Use a cold compress or cold pack on your breast between feedings to relieve pain and swelling. Never apply a cold pack directly to your skin because that can cause skin damage. Wrap it in a clean cloth or towel before use.
  • Gently massage your breast from the swollen area toward the nipple. Don’t massage aggressively or deeply, or you’ll increase the inflammation. The ABM recommends “gentle sweeping.”
  • Take pain medicine. Acetaminophen or ibuprofen can ease breast pain and symptoms such as muscle aches and fever.
  • Eliminate pressure on your breasts. Wear loose bras or go braless, and don’t sleep on your stomach.
  • Get support. Check in with your doctor or lactation consultant about how you’re doing. Make sure you get the guidance and emotional support you need to recover fully and continue breastfeeding.
  • Avoid soaks, such as Epsom salt soaks, which can further irritate and inflame the skin.
  • Treat hyperlactation. Producing too much milk can worsen the problem.
  • Consider therapeutic ultrasound. This treatment may help reduce inflammation and swelling. Ask your doctor or lactation consultant for a referral to a trained physician or physiotherapist.
  • Only take antibiotics if you have bacterial mastitis. Taking unnecessary antibiotics is never a good idea. Antibiotics can change the microbiome in the body and lead to antibiotic-resistant bacterial infections in the future.
  • Consider probiotics. Findings are mixed, but some research suggests that probiotics may help treat (and prevent) mastitis. Only certain, specific strains are useful for mastitis, however. (The strains belong to the species Limosilactobacillus fermentum or Ligilactobacillus salivarius, formerly called Lactobacillus salivarius). Ask your doctor or lactation consultant to help you choose an appropriate probiotic.

If the pain gets worse or you develop signs of an infection, you’ll need to do home treatment plus take an antibiotic to address the bacterial infection. Your symptoms should improve a day or two after you start taking the medication, but finish the whole course so you don’t get a repeat infection.

If your symptoms don’t improve after a day or two, contact your doctor. You may need to switch to a different antibiotic.

Can you still breastfeed with mastitis?

Yes, it’s completely safe to breastfeed with mastitis. In fact, breastfeeding can help you get better, although mastitis can temporarily reduce your milk supply in the affected breast. Even if you have a bacterial infection, your baby can’t catch it from you.

Nursing can be extremely painful when you have mastitis, but it’s crucial to help treat the condition, nourish your baby, and keep up your milk supply. Don’t nurse (or pump) more than usual, though, because you don’t want to produce an oversupply of milk.

Here are tips on managing the pain while you continue to nurse your baby or pump:

  • Start each feeding on the non-affected breast. If your breast is hard, you may need to pump or hand express just enough milk to soften your breast so that your baby can latch on easily.
  • Make sure your baby is positioned properly and latches on to as much breast tissue as possible.
  • Vary your nursing positions during each session to help empty your breast completely.
  • If nursing is unbearable, pump your breasts and give the milk to your baby in a bottle. Don’t pump more than necessary.

Even if you have a mild case of mastitis that resolves quickly, it’s important to talk with your doctor or a lactation consultant about how effectively your baby is nursing, so the problem doesn’t come back again.

How can I prevent mastitis?

There are some things you can do to lower your risk of getting mastitis:

  • Take care of yourself. The best way to prevent mastitis is to get plenty of rest and eat a healthy, balanced diet. (This is very difficult when you’re caring for a baby, of course.) The more run down you are, the more susceptible you are to illness.
  • Avoid letting your breasts become overly full. If your breasts feel full or hard between nursing sessions, pump or hand express a small amount of milk (not too much or you’ll boost your milk production).
  • Get help for nursing problems. If your baby is having trouble nursing (because of their latch or because you have sore nipples, for example), your breasts may become engorged. Ask a lactation consultant for guidance.
  • Be aware of nursing schedule changes. If your baby starts nursing less, you may need to pump just enough to relieve fullness. If you’re weaning your baby, do so gradually. Suddenly dropping a feeding can result in engorgement while your body adjusts to the change. Instead, gradually reduce the time you nurse during the feeding you want to drop.
  • Don’t wear tight bras or shirts. Make sure your bras fit properly. If there are any red areas on your skin when you take off your bra at the end of the day, the bra is too tight. Don’t wear underwire or strapless bras or tight swimsuits. Wear loose tops. Carry your purse or diaper bag so the straps don’t compress your breasts.
  • Take probiotics. Some research suggests that probiotics may help prevent mastitis in women who have had it before (see above).

Why do I keep getting mastitis?

If you’ve had mastitis before, you’re at higher risk of getting it again.

Mastitis that returns soon after you’ve had it may happen because the antibiotic you took didn’t work well enough (or you didn’t take the whole course). Sometimes a change in antibiotics is needed when one doesn’t address the specific bacteria at play. Your doctor can test your breast milk when you have an infection to identify which bacteria is causing the problem.

It’s also possible that you’re still having nursing problems that keep your breasts from draining fully. If that’s the case, talk with a lactation consultant. They can help you identify any contributing issues, such as a poor latch, cracked nipples, or engorgement.

If you have repeated bouts of mastitis, talk to your doctor. In very rare cases, recurring mastitis may be a warning sign of a breast tumor.

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