What is mastitis?
Mastitis is inflammation of the breast. If you suspect that you have it then you may notice the following symptoms:
- A sore, hot, red area of the breast.
- A hard lump that is often wedge-shaped.
- If the mastitis is infective then it will be associated with fever, chills and flu-like symptoms (Lawrence, 1990)
It is important to note that the inflamed breast may or may not involve a bacterial infection. In some cases, the breast may be sore, hot and/or red and the milk ducts are blocked but no active infection is present.
Causes of Mastitis
The following factors may influence whether a lactating woman develops mastitis (World Health Organisation, 2000).
- Missed or infrequent feeds
- Compression of the breast tissue (e.g. underwire bra, tight clothing, heavy massage, seatbelt, poorly fitted flange)
- Milk oversupply
- Nipple damage (i.e. a crack which may allow an infection to enter)
- Poor attachment which may result in inefficient removal of milk from the breast
- Weak suckling by the baby which may result in the milk not being removed efficiently
- Rapid weaning
- A white spot (blocked nipple pore, bleb, milk blister) on the nipple. A white spot can be caused by a bit of thickened milk or overgrowth of skin that creates a blockage at the tip of the nipple (Australian Breastfeeding Association, 2017)
- Illness in the baby/mother or fatigue in the mother
What Can Physio Do For You?
Therapeutic ultrasound provided by a Physio can help with blocked milk ducts and mastitis. Ultrasound is painless and helps with inflammation. It does this by sending sound waves deep into the breast tissue which create a mechanical vibration effect on the tissues. Taping can also be used to help breast swelling and your Physio can teach you how to do gentle manual lymphatic and fascial massage that will not hurt or compress the breast tissue.
What You Should Do?
- If you suspect you have mastitis and have a fever and flu-like symptoms then it is important to see a GP. They can determine whether you need a course of antibiotics.
- It is important to rest and have adequate fluids. You may use warmth on the breast prior to feeding to help with let-down and milk flow. Cold packs can be used following feeding or expressing.
- If it is safe for you to take it, an anti-inflammatory medication (e.g. ibuprofen) may also help with the inflammatory symptoms (i.e. red and hot). If unsure, check with your GP or pharmacist regarding anti-inflammatory medication.
- Ensure your hands are clean before handling your breasts to prevent introducing infection.
- Avoid overstimulating the sore breast tissue. Read below why we should not massage our breasts firmly.
- Ensure that you feed or express at suitable intervals so that your breasts do not feel uncomfortably full.
- Check that your attachment is correct. See a lactation consultant if this needs attention.
Understanding your Breast Anatomy
Too often during appointments we hear women speak of massaging their breasts very firmly to clear a blocked milk duct. It is important to know that our breasts are not like muscles! Breasts are made up of several different tissues:
- Adipose tissue (fat)
- Glandular tissue (milk producing cells)
- Ligaments that provide support and a framework for the breasts (Geddes, 2007)
The milk ducts transport milk to the nipple. They are small, close to the surface of the skin and are compressed easily (Geddes, 2007). They increase in diameter with the let-down reflex so it is thought that they are most important for transporting rather than storing milk (Geddes, 2007). The ducts travel from the nipple into the breast in an irregular fashion, much like the roots of a tree (Geddes, 2007).
The key points to take away from this information on breast anatomy is that the ducts are:
- Superficial rather than deep
- Compressed easily
- Travel along an irregular path
We need to keep this in mind when treating blocked milk ducts and mastitis as they can be caused by compression of the ducts (Geddes, 2007). It is important not to massage the breasts heavily. Stroke them no harder than stroking a cat. Breasts that are producing milk are not muscles! Also check your bra is not too tight and compressing the ducts.
Australian Breastfeeding Association (2015) White spot on the nipple. Available at: https://www.breastfeeding.asn.au/bfinfo/white-spot-nipple (Accessed 9th August 2017).
Geddes, DT. (2007). Inside the Lactating Breast: The Latest Anatomy Research. Journal of Midwifery & Women’s Health, 52 (6), 556 – 563.
Lawrence, RA. (1990). The puerperium, breastfeeding, and breast milk. Current Opinion in Obstetrics and Gynecology, 2, 23 – 30.
World Health Organisation (2000). Mastitis: Causes and Management. Publication number WHO/FCH/CAH/00.13. World Health Organisation, Geneva.