Mastitis & Clogged Ducts
*Note: This blog is only intended for informational purposes. Always consult your lactation consultant and healthcare provider for all lactation and medical circumstances and decisions.
What is Mastitis?
The term “mastitis” means “inflammation of the breast”. Inflammation can be present with or without a bacterial infection; however, clinically, mastitis is defined as having a breast infection, which presents with a reddened, tender, and hardened wedge-shaped area of the breast, along with a fever (100.4 - 101.3 degrees F is considered a fever, depending on where the temperature reading is taken) or greater and flu like symptoms (i.e. chills, body aches, fatigue).
A common progression of symptoms are as follows:
Engorgement, inflammation, and/or plugged ducts → inflammatory mastitis → bacterial mastitis → abscess
Definitions:
Engorgement: Typically presents in the first couple of weeks postpartum when your breastmilk dramatically increases in volume. Your breasts may feel hard, uncomfortable, hot, and you may have difficulty expressing breastmilk due to the inflammation and edema. If you received IV fluids during your birth, you may be more at risk for engorgement.
Plugged ducts: A plugged duct is when a milk duct (which milk travels through in the breast) becomes clogged, typically involving milk duct inflammation and narrowing. You may notice a tender area of your breast and you may possibly feel a new round knot that does not go away with breastfeeding, pumping, and massaging the area.
Inflammatory mastitis: When ductal narrowing and inflammation persist and worsen, we progress into inflammatory mastitis. Typically, an area of the breast (commonly wedge-shaped, or isolated to a specific area of the breast) is reddened, hot to the touch, tender, and hardened. This indicates inflammation and irritation within the breast. It is possible for your body to respond with a systemic inflammatory response, causing symptoms such as fever and chills, even if you do not have a bacterial infection that requires antibiotics.
Infective (bacterial) mastitis: If you continue to have systemic symptoms (fever, chills, bodyaches, etc.) for >24 hours, along with breast symptoms (redness, pain, etc.), you should be assessed by your Healthcare Provider to rule out bacterial mastitis (in which case, antibiotics are recommended). Infective mastitis is inflammation of the breast, along with a bacterial infection.
Abscess: An abscess occurs when an infection of the breast (bacterial mastitis) is left untreated or if the prescribed antibiotics are resistant against the bacteria, causing a build-up of pus in the infected area. If a red, tender, hardened area persists, despite treatment, you may have an abscess. If your mastitis symptoms do not significantly improve within 24-48 hours of starting antibiotic treatment, please contact your OB/GYN or healthcare provider; you may need a culture to determine the bacteria that’s present and a new antibiotic that is effective against the bacteria. Your doctor may also order an ultrasound if they suspect an abscess. If you do have an abscess, needle aspiration will likely be necessary.
**Note: It is considered safe and recommended for your baby to continue to breastfeed or receive breastmilk from a breast that has mastitis or an abscess. If an abscess requires aspiration, it is advised that your infant's mouth is not in contact with the wound. Consult your HCP for medical advice specific to your situation.
What are plugged duct symptoms?
Tender area on the breast
A lump (may feel like a pea or a grape) that is sensitive to touch and not going away with breastfeeding and/or pumping.
Stringy or clumpy breastmilk (you may notice if pumping)
Milk flowing slower than normal on affected side (baby may became frustrated by this)
**If you have flu-like symptoms (fever, chills, or body aches), this can indicate inflammatory or bacterial mastitis - see below.
What are Mastitis symptoms?
Reddened (and/or red streaks), tender, and hardened area on the breast
Along with . . .
Fever (100.4 - 101.3 degrees F is considered a fever, depending on where the temperature reading is taken)
Chills
Fatigue
Body aches
What causes Mastitis?
Mastitis is most common during the first two weeks postpartum (likely due to engorgement). There are several factors that can predispose you to mastitis:
Nipple damage
Skipping a breastfeeding or pump session
Infant not removing milk effectively (i.e. tongue tie, incorrect latch and/or positioning techniques)
Pressure on the breast, causing a plugged duct (i.e. sleeping in a certain position, a seatbelt, etc.)
Illness in the infant (introducing bacteria to the nipple)
Inflammation in the breast
What is the difference between Mastitis and plugged ducts?
A plugged duct is when milk in an area of the breast becomes unable to move, which causes a back-up of milk from behind it (think traffic jam). Mastitis is a bacterial infection within the breast, which can occur because of a plugged duct or independent of a plugged duct. Plugged ducts predispose you to mastitis. Plugged ducts do not always become mastitis. Mastitis may or may not be caused by a plugged duct. If you are treated with antibiotics for mastitis, you still need to continue the plugged duct protocols to help keep the milk flowing and to prevent “milk stasis” (when breastmilk just sits in the breast). Antibiotics treat infection; they do NOT clear a plugged duct.
Protocols for Plugged Ducts and Mastitis
If you have a plugged duct, tenderness, and/or redness on the breast:
Nurse (or pump) frequently, on demand.
Apply moist heat to the affected breast prior to breastfeeding or pumping
*Heat will worsen symptoms for some people - use caution when applying heat and use in short increments (ex. Up to 5 minutes); discontinue heat if symptoms do not improve or worsen.
Gentle (i.e. light stroking) lymphatic drainage massage of the affected breast with a food-grade oil (olive, coconut, etc.) before/during breastfeeding/pumping. Avoid vigorously massaging breast tissue.
Position the baby so that the baby’s chin is pointing toward the affected area.
Ibuprofen (if approved by your HCP). Ibuprofen can reduce pain and inflammation.
Other natural remedies to be considered:
*This is not meant to recommend treatment; it is meant for educational purposes only. Always discuss any supplement with your healthcare provider
Hydration - drink to thirst. For electrolytes, you can try coconut water, pre-made electrolyte drinks, or a pinch of salt and squeeze of lemon in your water.
Cold compresses - Applied to the breast (not the nipple) between feedings. Cold compresses can help to decrease inflammation and pain (1). Be sure to have a cloth barrier between the ice pack and breast. Don’t apply ice for longer than 10-15 minutes at a time, up to once per hour.
Sunflower Lecithin - lecithin is an emulsifier, which essentially means it may decrease the viscosity (stickiness) of breastmilk, and may also reduce ductal inflammation (1)
Choline - Similarly to lecithin, choline may decrease the viscosity (stickiness) of breastmilk, and may also reduce ductal inflammation. Sunflower lecithin is broken down into choline in the body.
Raw garlic - Kellymom recommends a minimum of 2-3, and ideally 4-5 garlic cloves per day upon realizing pending mastitis symptoms (2). She explains that allicin, the chemical property that gives garlic its strong odor, also acts as a broad spectrum antibiotic. These antimicrobial properties are shown to be effective against infection. Raw garlic is preferred over garlic capsules due to the processing that occurs to manufacture capsules. Tip: chop garlic finely and swallow using juice.
Probiotics - multiple studies have shown that probiotics (specifically lactobacillus fermentum and/or lactobacillus salivarus strains) are effective in both preventing and treating mastitis.
Vitamin C megadose - Kellymom recommends 3000-5000mg of vitamin C daily (2)
Echinacea tincture - Echinacea has immune boosting properties. Kellymom recommends taking 3-4 times per day (2).
Rest - accept help with meals, holding the baby (between feedings), and other children at home. Rest is very crucial for any healing process. Your body needs rest to fight infection.
Warm Shower or compress - No longer routinely recommended. Studies have not found heat to be effective in improving mastitis outcomes (1). That being said, heat may provide comfort to some people, and it may worsen symptoms for others due to increasing inflammation (use with caution). Apply moist heat on the breast (careful not to burn yourself, it shouldn’t be uncomfortable) can help milk to be expressed. It is not recommended to apply heat for longer than 5 minutes due to the risk of increasing inflammation.
Silicone hand pump (i.e. haaka) - No longer recommended, due to potentially exacerbating nipple trauma and edema of the breast (1).
References
1. Mastitis and Abscess Protocols and Considerations
Academy of Breastfeeding Medicine Protocols
https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf
2. Mastitis Natural Remedies
https://kellymom.com/bf/can-i-breastfeed/herbs/natural-treatments/
3. Probiotics and Mastitis Prevention and Treatment Studies
4. Garlic and mastitis treatment studies
5. Sunflower lecithin and plugged ducts
https://kellymom.com/nutrition/vitamins/lecithin/
*02/08/23 – Blog updated based on current evidence-based clinical protocols. See Academy of Breastfeeding Medicine resource above.
