Lactational mastitis is an inflammation of breast tissue that develops during breastfeeding. It is seen most often in the first weeks after birth and usually affects one breast. Cracks in the nipple, incomplete emptying of milk and the entry of bacteria into the milk ducts are the main factors that commonly lie behind it.
What starts as hardness, redness and pain can, if not evaluated early, come with fever and fatigue, and in some cases progresses to a collection of pus, that is, an abscess. Sores, crusting and poor hygiene on the nipple make it easier for bacteria to multiply, and a share of untreated infections can turn into mastitis.
This page outlines the symptoms, the diagnostic approach and the treatment options. The information does not replace an examination; mothers who notice a red, painful breast together with fever are advised to see a doctor without delay.
Symptoms
Lactational mastitis usually becomes obvious within a few hours to a day. The affected area of the breast becomes firm and tender, and the skin over it turns red and feels warmer than the surrounding tissue.
- A hard, tender, warm area in the breast, or wedge-shaped redness
- Burning or stabbing pain that increases during feeding
- Fever, chills, muscle aches and a general feeling of being unwell
- Cracks, sores or crusting on the nipple
- Tender lymph nodes in the armpit
If treatment is delayed despite these symptoms, a softening collection with a fluctuant feel may develop inside the firm area; this suggests an abscess. A persistently high fever, rapidly spreading redness or marked exhaustion in the mother calls for evaluation without losing time.
Diagnosis
Diagnosis rests largely on clinical assessment. The doctor asks about the breastfeeding history, when the symptoms began and the condition of the nipple, and examines the breast to locate the hardness, warmth and redness.
If the examination finds an area with a fluctuant feel, or if complaints continue despite treatment, an ultrasound is performed. Ultrasound distinguishes inflamed tissue from an abscess collection and, when needed, guides the drainage procedure. Mammography is rarely needed at this stage and is usually not the first choice in a painful breast.
- A culture may be taken from fluid drained from an abscess; this helps in choosing the appropriate antibiotic.
- In cases that do not respond to treatment or recur often, a biopsy may be needed, although rarely, to exclude other breast diseases that look similar.
Evaluation should not be neglected if the problem continues after the breastfeeding period ends, since some tumours that cause redness and hardness can mimic inflammation.
Treatment
When no abscess has formed and only signs of inflammation are present, treatment rests on three principles: regular emptying of the milk, control of pain and fever, and antibiotics when needed. The dose and duration are set by the doctor for each patient.
- Continuing to breastfeed is generally recommended because the milk is not harmful; good emptying of the affected breast by the baby helps the inflammation settle.
- If feeding is insufficient, regular expression of milk with a pump or by hand lowers the risk of an abscess.
- Analgesics compatible with breastfeeding may be used for pain and fever on the doctor's advice.
- The antibiotic is chosen from the group regarded as safe during breastfeeding, taking possible resistance into account.
When an abscess develops, antibiotics alone are not enough; needle drainage under ultrasound guidance is preferred in most cases, while a large or multi-chambered abscess may need surgical drainage through a small incision. At this stage too, the doctor decides whether breastfeeding can continue.
For more detail on surgical options and the surgical process, see the Breast surgery page.
