Understanding Mastitis

What is Mastitis?

Mastitis is an inflammatory condition of the breast tissue that most commonly occurs during breastfeeding. It typically causes pain, swelling, warmth, and redness in the affected area, often accompanied by flu-like symptoms such as fever and chills.

It is one of the most common reasons mothers consider stopping breastfeeding earlier than planned. But with the right management, most cases resolve fully — and continuing to breastfeed is not only safe but usually recommended as part of recovery.

The WHO recommends exclusive breastfeeding for the first six months of life. Mastitis does not have to be a barrier to reaching that goal.

What Causes Mastitis?

The 2022 Academy of Breastfeeding Medicine guidelines describe mastitis as an inflammatory spectrum condition — not simply a blocked duct or a bacterial infection. The primary drivers are now understood to be oversupply (hyperlactation) and an imbalance of the breast's natural bacterial environment, known as dysbiosis.

Additional triggers include incorrect latch positioning, infrequent or suddenly disrupted feeding patterns, and ill-fitting nursing bras that apply pressure to breast tissue.

Is it Always a Bacterial Infection?

No. While bacterial mastitis does occur — commonly involving Staphylococci — many cases are inflammatory in nature and do not involve a bacterial infection. Treating all mastitis with antibiotics is therefore not appropriate and may be counterproductive.

A milk culture test can help confirm whether a bacterial infection is present. Where there is clinical uncertainty, this is worth requesting before a course of antibiotics is prescribed.

Signs and Symptoms to Watch For

The most common signs of mastitis include breast pain, swelling, and redness — typically affecting one breast more than the other. These are often accompanied by systemic symptoms such as fever (38°C or above), chills, body aches, and fatigue that can feel similar to the flu.

Symptoms can develop rapidly, sometimes within a few hours. If your condition does not begin to improve within 24 to 48 hours of home management, seek medical advice promptly — do not wait it out beyond this window.

If you notice a hard, painful lump that does not improve alongside your other symptoms, seek urgent medical attention. This may indicate a breast abscess — a complication of untreated mastitis that requires a different course of treatment and should not be managed at home.

How to Treat Mastitis — Current Clinical Guidelines

Management of mastitis has changed significantly based on updated clinical evidence. The priority is reducing inflammation, not aggressively draining the breast.

• Apply ice packs or cold compresses to the affected breast to reduce inflammation. Current guidelines now recommend cold therapy over heat — heat has been shown to worsen swelling and is no longer advised.
• Use NSAIDs such as ibuprofen as the preferred first-line option for managing both pain and inflammation.
• Continue breastfeeding or pumping on your normal schedule. Do not increase feeding frequency in an attempt to "drain" the breast — this can worsen oversupply, which is often a root cause.

What to Avoid

Several practices that were once commonly recommended are now classified as outdated and potentially harmful according to current guidelines:

• Deep or aggressive breast massage
• Excessive pumping beyond your normal feeding schedule
• Epsom salt soaks
• Dangle feeding (positioning the baby below the breast while feeding)

These approaches can increase inflammation and worsen the condition. Reserve antibiotics for confirmed bacterial mastitis or cases that show no improvement after 24 to 48 hours of conservative care.

Preventing Mastitis

The most effective prevention strategies centre on responsive feeding and ensuring good latch technique from early on.

• Feed on demand, following your baby's natural hunger cues rather than a fixed schedule.
• Ensure correct latch and positioning — if you are unsure, a consultation with a certified lactation consultant is one of the most valuable investments you can make in the early weeks.
• Avoid anything that applies sustained pressure to breast tissue, including underwire bras or tight clothing.
• Avoid sudden changes to feeding frequency, such as abruptly dropping a feed or going long stretches without nursing or pumping.

Emerging research also points to the role of specific probiotic strains in both preventing and managing mastitis. Strains including Limosilactobacillus fermentum and Ligilactobacillus salivarius have shown potential in clinical studies to support a healthy breast microbiome. These are not a replacement for good feeding practice, and you should consult your doctor before starting any probiotic supplement during breastfeeding.

Supporting Lactation with the Right Nutrition

Recovery from mastitis places additional demands on the body. Ensuring adequate nutrition during this period supports both tissue repair and continued milk production.

Key nutrients to prioritise include:

• Protein — essential for tissue repair and immune function. Good sources include eggs, lean meat, fish, tofu, and legumes.
• Iron — to help replenish stores, particularly if fever or infection has been present. Found in red meat, spinach, lentils, and fortified cereals.
• Calcium and DHA — important for maintaining breast milk quality throughout the breastfeeding period.

For breastfeeding mothers who find it difficult to meet these nutritional needs through diet alone, PROMAMA is scientifically formulated with key nutrients including DHA, calcium, and iron to support postpartum recovery and sustained lactation. It is carefully crafted to address the specific nutritional demands of breastfeeding mothers at every stage of their feeding journey.

Always consult your healthcare provider or a registered dietitian about your individual nutritional needs, particularly during recovery from a mastitis episode.