What mastitis is and why it occurs
Mastitis is an inflammation of breast tissue that commonly occurs in the postpartum period in connection with breastfeeding or pumping. It can be triggered by impaired milk flow and tissue swelling and may develop an inflammatory component. In some cases, a bacterial infection is added.
Many guidelines therefore describe mastitis not as a yes-or-no condition but as a continuum from milk stasis and inflammation to bacterial mastitis and, rarely, abscess. A useful overview is the Clinical Protocol from the Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine: Mastitis Spectrum, Protocol 36
Typical symptoms: how mastitis feels
The most important point is the combination of local breast symptoms and your general condition. A blocked duct can hurt, but mastitis often adds a clear feeling of being unwell.
Local signs
- Pain that is clearly stronger than normal pressure during breastfeeding
- Redness, warmth, swelling, sometimes wedge-shaped
- Tenderness to pressure or a firm area
- Sometimes a visible tense line or a very sensitive spot
Systemic signs
- Fever or chills
- Body aches, fatigue, general malaise
- Rapid deterioration within hours
A clear, accessible summary of mastitis, including typical symptoms and treatment, is also available from the NHS. NHS: Mastitis
Blocked duct or mastitis: a short distinction
Many start with a hard area and think of a blocked duct. The shift to mastitis often becomes apparent less as a single lump and more from the overall course.
More likely a blocked duct
- Local lump or pressure, but you otherwise feel relatively fine
- No persistent systemic symptoms
- It improves noticeably with appropriate measures within 12 to 24 hours
More likely mastitis
- Fever or a marked feeling of illness develops
- Redness and pain increase and spread
- You become clearly worse instead of better
What really helps: treating mastitis without drama
The goal is to calm the inflammation, restore steady milk flow and avoid overstimulation. Many worsen things unintentionally by pumping too aggressively or massaging too hard when stressed.
Continue breastfeeding or express, but physiologically
In most cases it is sensible to continue breastfeeding or to express gently. Abruptly stopping can increase pressure and worsen the inflammation. The key is to avoid turning expression into a forced process.
- Breastfeed on demand, without extra marathon sessions
- If pumping is necessary, do so moderately and without maximum suction
- Vary positions to support drainage from different areas
Cooling, rest, reduce inflammation
Between feeds, cooling helps many people because it reduces swelling and eases pain. Rest is not a luxury but part of treatment. If you can, reduce tasks for 24 hours and prioritise sleep, fluids and food.
Gentle touch rather than deep kneading
Strong massage on a painful area can further irritate tissue. Often more helpful is gentle, superficial support and reducing external pressure, for example with loose clothing and positions without compression.
Antibiotics for mastitis: when they make sense
Antibiotics are not automatically the first step. They are mainly relevant when bacterial mastitis is likely or when the course does not move towards improvement.
Situations where antibiotics are more often needed
- Marked feeling of illness and persistent fever
- Rapid worsening despite consistent basic measures
- No clear improvement within about 24 to 48 hours
- Recurrent mastitis or particular risk factors
If an antibiotic is prescribed, that usually does not mean you must stop breastfeeding. Many antibiotics are compatible with breastfeeding, but selection should be made by a clinician because allergies, local resistance patterns and your clinical course matter.
A helpful resource on medicines in breastfeeding and their evaluation is LactMed, though the specific choice should always be individualized. LactMed: Drugs and Lactation Database
When you should get assessed
Mastitis is an area where early assessment often relieves symptoms faster than enduring the problem for days. Course and systemic signs are especially important.
Seek assessment if
- Fever appears or does not go down
- You have chills, severe body aches or marked exhaustion
- Redness and pain increase or spread
- No clear improvement after 24 to 48 hours
- You get mastitis repeatedly
Seek immediate help if
- You feel very unwell, dizzy or develop circulatory problems
- You have severe, increasing pain with a tense, highly red breast
- You suspect an abscess, for example a clearly defined, very painful, fluctuant swelling
For orientation on warning signs after childbirth that should be medically assessed, ACOG can be helpful, although the assessment is always individual. ACOG: Warning signs of postpartum health problems
Abscess: rare but important to know
A breast abscess is a collection of pus that can develop as a complication. It is overall rare but important because it usually requires targeted treatment, such as drainage, in addition to anti-inflammatory care.
Signs may include a well-defined, very painful swelling that does not improve, and a course that stalls or worsens despite measures and possibly antibiotics. If you suspect this, timely assessment is important.
Common pitfalls that can prolong mastitis
- Overly aggressive pumping out of fear, which can increase swelling and irritation
- Strong massage and deep kneading of the inflamed area
- Continuous heat, which can promote swelling in inflammation
- Compression from tight clothing or pressure while lying down
- Waiting too long despite fever and marked deterioration
If you notice that you are only reacting and not getting better, that is a good signal to seek help.
Conclusion
Mastitis is more than a blocked duct, because it is often accompanied by a marked feeling of illness and fever. The basics are calming inflammation, physiologic emptying, cooling and reducing pressure. Antibiotics are mainly useful when bacterial mastitis is likely or when there is no improvement. If you feel systemically unwell, have fever or the course worsens, early assessment is the safe step.
