Mastitis: Causes, Symptoms, Risk Factors, and Treatment

Mastitis occurs when the glandular tissue (milk-producing glands/lobules) becomes swollen & inflamed. This swelling causes the ducts (tiny milk transport tubes) to tighten, making it harder for milk to flow—similar to a clogged sink drain.

A Clogged Sink Analogy

Imagine a kitchen sink where water (milk) is supposed to flow smoothly down the drain (milk ducts). If food particles (milk build-up) start to clog the pipe, water flow slows down, causing a backup. As pressure builds, the stagnant water can become murky & thick, making it even harder to clear. If the clog isn’t addressed, the water may overflow, leading to a bigger mess (inflammation & infection).

To fix the problem, you wouldn’t stop running water entirely (stop breastfeeding); instead, you’d try to gently flush the clog—by continuing to breastfeed, using gentle massage, & applying ultrasound therapy to break up blockages & get things moving again. If the blockage persists, stronger intervention such as antibiotics may be necessary, but should not be used as a first line treatment.

Symptoms

Identifying the signs early is essential for timely intervention & effective resolution. You may notice a tender lump that appears red, pink, brown, or grey, depending on your skin tone (mastitis can still occur without visible skin changes), accompanied by flu-like symptoms such as chills, fever (typically around 38.4’C), & general body aches or feeling run down. These signs indicate inflammation & discomfort, & it’s important to seek support to manage your symptoms & prevent further complications. 

Risk Factors for Mastitis

Similarly, when mastitis develops, milk flow is disrupted, & if not addressed quickly, it can escalate within hours. These issues create stagnant milk buildup, increasing the risk of bacterial imbalance &  inflammation. However, mastitis does not occur from simply not feeding once—it results from ongoing stress on the ducts & glandular tissue. It is often caused by:

• Blocked ducts (tiny milk transport tubes)– Milk flow becomes obstructed, leading to buildup &  inflammation.
• Overly full breasts (engorgement)– Excess milk can put pressure on ducts, making it harder for milk to flow.
• Attempting to completely empty the breasts– This can trigger an oversupply response, increasing the risk of engorgement and blocked ducts.
• Excessive pumping & incorrect flange sizing– Overpumping can lead to increased inflammation & swelling, while an improperly fitted pump flange can cause ineffective milk removal, leading to blockages & further irritation.
• Baby oral dysfunction– Conditions such as tongue tie or a poor latch can cause ineffective milk transfer, leading to milk stasis.
• Prolonged breast compression– Pressure from seat belts, baby carriers, heavy bags, or tight bras (especially those with underwire) can block milk flow & contribute to duct obstruction.
• Extended feeding intervals– Going long periods between feeds can lead to milk stasis, increasing the risk of duct blockage and inflammation.

Treatment & Management – The BAIL Approach

The BAIL approach is an effective way to manage mastitis & promote healing from home.

Note – Your breastmilk remains safe for your baby. Mastitis may cause a temporary refusal of the breast or expressed milk due to a saltier taste. If this occurs, take a deep breath & know that this is temporary. With patience & gentle encouragement, you can help them to continue to breastfeed/bottle-feed with your expressed milk.

• B – Breast rest, but not stopping feeding– Continue to breastfeed on demand/expressing, but avoid excessive pumping, which can worsen inflammation.
• A – Apply ultrasound therapy– This helps break up blockages & reduce swelling & inflammation. Treatment with a professional ultrasound machine is recommended. Consider Anti-inflammatory & pain relievers, such as regular ibuprofen & paracetamol, to help manage discomfort.
• I – Inflammation reduction– Use cold compresses on the affected area to ease swelling & discomfort. A wet then frozen nappy is a useful tool if you don’t have an ice pack at home, as it molds perfectly around your breast.
• L – Latch positioning & lymphatic drainage massage– Ensure a deep, effective latch to optimise milk transfer. Different breastfeeding positions may help drain different areas of the breast. Lymphatic drainage massage—a gentle technique that encourages fluid movement—can help reduce swelling & promote healing.

Seeking Support for Mastitis

If you’re experiencing mastitis, book an appointment with me here for a tailored treatment plan & expert guidance & support. While antibiotics can play an important role in treatment when needed, generally with severe bacterial mastitis, they should not be considered as the first step. In many cases, mastitis can be managed effectively without them, using the steps above. If your doctor recommends antibiotics, it’s best to request a breastmilk culture prior to commencing them. This helps ensure the prescribed medication is tailored for your specific situation, leading to the best possible recovery. Doctors provide invaluable care, but an IBCLC is a highly specialised field. Because mastitis treatment can vary, working with me can help you develop a tailored plan to support your healing & accelerate your road to recovery .