Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 29, 2016

There are medical conditions that affect the breasts during various periods of a woman’s life, and one particular condition, mastitis, typically affects women who have recently given birth. Mastitis is an inflammation of usually one breast which usually occurs within 6 to 12 weeks after the birth of a child, and the condition can further develop during the breastfeeding phase.


Definition & Facts

Mastitis occurs in about 10 percent of women that breastfeed and rarely affects women who are not breastfeeding. This inflammation of breast tissue can be caused by an infection of the breast tissue, and symptoms often include pain, redness, and swollen breasts. Mastitis affects a new mother's ability to breastfeed her child, which in turn affects the health of the newborn and his or her development.

Symptoms & Complaints

The symptoms of mastitis vary depending on the type of infection involved, but the most common symptoms include breasts that feel hot to the touch, breasts that are extremely tender to the touch, breasts that have burning sensations, breasts that are shiny and red along with nipples that are cracked and which may ooze pus.

Additional symptoms may include the presence of flu-like symptoms such as aches, pains, fever, nausea, vomiting, chills, and shivering. Women with mastitis complain of pain, fatigue, weakness, discomfort, and breast heaviness and fullness.

Some women experience anxiety, psychological stress, and depression along with associated thoughts of low self-worth, particularly when they are unable to adequately breastfeed their babies due to mastitis. Sometimes women are led to make choices about breastfeeding because of mastitis, so they turn to breast pumping, bottle feeding and baby formulas.


Mastitis can be infectious or non-infectious. The non-infectious variety of mastitis is usually caused by milk staying inside the breast tissue (milk stasis), which is due to a blocked milk duct or breastfeeding complications. Those complications can occur when a baby is not connecting to the breast correctly while feeding, or the baby is having trouble sucking the milk from the breast, or the baby is simply not being breastfed on a regular basis. Other problems could occur with milk duct blockage because of possible pressure on the breast from tight clothing and other compression. 

The infectious type of mastitis is thought to originate with the blockage of milk ducts and the susceptibility of stagnated milk inside the breasts to infection. Bacteria can live on the skin of the breasts and could enter the breast directly through cracks and breaks on the breast or nipples. There could also be bacteria in a baby's mouth that might be transferred as well through breastfeeding.

A rare form of infectious mastitis can occur with women who are not breastfeeding (non-lactating) called periductal mastitis. There are some women who are smokers who develop mastitis. This condition usually happens in the late twenties and early thirties. Smoking can cause damage to the milk ducts, which opens them up to infection. Also, in relation to this same age group and younger, nipple piercings that get infected can lead to mastitis. 

Diagnosis & Tests 

Mastitis is not difficult to diagnose. A primary care doctor or a general practice physician will base a diagnosis on the symptoms and a physical examination of the affected breast. Diagnostic tests are usually not required but may be administered to verify a diagnosis. If a treatment regimen is prescribed and there is no response, a sample of breast milk will be taken for further testing. Tests will determine whether the infection is bacterial as well as the type of bacteria present. Pinpointing the bacterial type will determine the best course of treatment. 

If the physician feels that the mastitis is caused by improper breastfeeding, the patient may be asked to show how she breastfeeds her child. Further diagnosing and testing would include checking for a rare form of breast cancer (inflammatory breast cancer), which can exhibit the same type of mastitis symptoms concerning redness and swelling. Testing for this would require a biopsy to determine the presence of cancer.

Treatment & Therapy

The treatment for non-infectious mastitis involves self-care procedures that include the patient drinking adequate liquids, getting plenty of rest, taking over the counter medications such as acetaminophen for pain and fever relief, feeding the baby more regularly, pumping the breasts if necessary, and feeding from the breast that is affected by mastitis (helps with drainage).

The patient may also ensure correct positioning when feeding, try out various feeding positions for effective feeding and drainage, warm the breast before feeding for easier transfer of milk to the baby, utilize breast stroking for more even milk flow, and wear looser clothing and avoid form fitting clothing. In addition, aspirin is not to be taken for pain and fever relief because of its association with Reye's syndrome.

Treatment for infectious mastitis normally includes administering an antibiotic along with the various procedures listed with the non-infectious mastitis information. Antibiotics may be present in the breast milk and passed on to the baby, which may result in loose bowel movements and restlessness, but it will not be damaging to the baby and the medication effects will gradually disappear once treatment is finished. If the treatment is not effective, another round of antibiotics may be recommended to eliminate the infection, and a culture may be ordered to find an alternative antibiotic. 

Additional treatment for mastitis may involve abscess drainage, particularly if treatment had not been administered properly. Pus can collect in the breast and it would need to be drained surgically to alleviate the abscess. 

Prevention & Prophylaxis

One of the easiest preventative measures for mastitis is proper breast-feeding techniques. They can help eliminate and alleviate the sore and cracked nipples that can cause mastitis. The right positioning of the baby and the baby's direct attachment to the breast area for feeding is critically important.

In addition, there are techniques such as allowing the nipples to dry after breast feeding sessions and the use of creams specifically designed for easing the pain and soreness of cracked nipples. Consuming the right foods and drinking adequate water, particularly while breast feeding is very important as well. 

Preserving the breasts with the proper bra is vital, particularly when breasts are engorged and wearing the right clothing in the breast area is always important. Breast pumping can preserve precious milk from engorged breasts and can help with proper drainage, especially when breast feeding is tapering off and weaning is part of the next phase of feeding a growing baby. Mastitis can be prevented with the right procedures in place from the beginning of breast feeding all the way through to the weaning process. 

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