The mastitis updates you need to know

First of all - what even is mastitis?

The usual definition of mastitis is a tender, hot, swollen, wedge shaped area of breast associated with a temperature and flu-like symptoms.

But did you know that mastitis literally means inflammation of the breast. This inflammation may or may not involve a bacterial infection.

It's likely that it goes like this:

Engorgement -> Non-infective Mastitis -> Infective Mastitis -> Breast Abscess

What can cause it?

Well, it’s a long list. Including:

• Damaged nipples

• Infrequent or scheduled breastfeeds

• Missed breastfeeds

• Poor attachment or weak suck

• Illness in mum or baby

• Oversupply of milk

• Rapid weaning

• Pressure on the breast (e.g., tight bra)

• Blocked nipple pore or duct (milk blister/bleb)

• Stress and fatigue

Old recommendation:

Keep breasts as close to empty as possible

New recommendation:

Feed baby on demand, and do not aim to empty breasts 

Why?

Repeated feeding will suppress feedback inhibitor of lactation (FIL), which will result in increased milk production. This will worsen the inflammation and ductal narrowing.

Old recommendation:

Use a breast pump to keep breasts as close to empty as possible 

New recommendation:

Minimise breast pump usage 

Why?

Pumping does not provide the opportunity for bacterial exchange between baby's mouth and your breast. This can change the milk microbiome (aka. microorganisms in the milk). Breast pumps can also cause trauma. 

Old recommendation:

Use massage to relieve symptoms  

New recommendation:

Avoid deep massage of the breast. Instead use manual lymphatic drainage with light sweeping of the skin.  

Why?

Deep massage causes increased inflammation, tissue oedema (swelling), and microvascular injury. 

Other recommendations: 

• Avoid the use of nipple shields as they can result in inadequate breast milk extraction
• Wear an appropriately fitting supportive bra (without underwire)
•  Avoid saline soaks, castor oil, and silicone breast pumps filled with Epsom salts as these can macerate the skin  

What to focus on?

• Holistic support from an IBCLC and GP
• Feed on demand, not to 'empty' breasts 
• Decrease inflammation and pain with ice and non steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen
• Consider therapeutic ultrasound and manual lymphatic drainage 
• Discuss with your doctor the use of antibiotics for bacterial mastitis only
• Consider probiotics 

Mastitis is a literal pain, so please get support early.

As always, you’ve got this mama, and I’ve got you.

Source: Academy of Breastfeeding Medicine.