What is mastitis?
Mastitis is an infection caused when a blocked milk duct is not relieved. About 10% of breastfeeding mothers will suffer with mastitis at some point, but it can affect all new mothers (including those who have chosen to bottle feed) when your milk comes in after giving birth.
Mastitis is most common in your baby's first three months but occurs frequently in the second and third week once breastfeeding has become established. You can also be more susceptible to blocked ducts and mastitis when there are changes in your baby’s feeding pattern. Normally, only one breast is affected.
Mastitis that is left untreated can lead to infection requiring treatment by antibiotics. In the most severe cases, untreated mastitis can cause a breast abscess which would require an operation.
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What are the signs that I have blocked milk ducts?
Knowing how to spot a blocked milk duct will allow you to treat it and prevent the development of mastitis. You should look out for the following symptoms:
A red and swollen patch of skin
A painful, engorged lump in your breast
A white spot on your nipple known as a ‘bleb’ – this can look like a milk-filled blister and is due to an overgrowth of skin cells
The surface of your breast may be tender or hot to touch
A blocked duct will generally feel more painful before feeding with a noticeable feeling of relief after feeding
Milk supply may decrease temporarily as it can’t be released effectively.
You may notice ‘stringy’ milk when expressing, or grains of thickened milk.
How do I know if I have mastitis?
Blocked ducts that are treated promptly will usually clear within a couple of days without developing into mastitis. However, if you suspect that it may have developed into mastitis, you might also notice the following symptoms:
Intense pain, swelling and redness
Flu-like symptoms and a feeling of being tired and achy
A fever and chills with a high temperature over 38.5°C
Expressed milk may look lumpy, although it is still safe for your baby.
If you are not feeling better within 24 hours or you notice other symptoms such as pus or blood in your milk or red streaks on your breast, then you should see your GP, who may prescribe antibiotics.
How do I know if I have a breast abscess?
Breast abscesses only affect a small percentage of women who have had mastitis – roughly 3%. If your mastitis symptoms aren’t treated, then it’s possible they may led to a breast abscess. Even if you have been treated for mastitis, the persistence of symptoms can indicate that an abscess has developed alongside the mastitis. If you suspect an abscess, it is important that you seek medical advice straight away.
An abscess is a pus-filled hollow just beneath the skin that is surrounded by hard, inflamed tissue that feels like a lump. It’s caused by a bacterial infection. The presence of an abscess will usually be determined by an ultrasound. If it is an abscess, it will need draining. This can be done with a needle if it's small, or through a small cut, if it's large. Either way you’ll usually be given a local anaesthetic before the procedure.
Mumsnetters who've had abscesses strongly recommend insisting on a referral to a breast-specialist consultant and, if you want to continue breastfeeding, seeking advice from a breastfeeding-specialist midwife.
Most women who have breast abscesses or severe mastitis continue to breastfeed as normal following treatment.
“I had an abscess with my first son as the result of mismanaged mastitis. I was gutted that it had all gone so wrong and it took a long time to get over it. I worried about what it would be like with a second child but he’s now 13 months and I’m still breastfeeding him. It’s been a completely different experience and I have no idea when I'll stop feeding him as it’s all so easy. No mastitis at all this time, not even a sore nipple.”
What causes blocked milk ducts and mastitis?
Blocked ducts are caused by a build-up of milk that obstructs the flow to the nipple. This build-up can be caused by a variety of factors.
Poor milk drainage is the most common reason for blocked ducts. This can either be caused by not feeding your baby frequently enough or because you’ve dropped a feed.
If your baby’s latch or position is not right, it can prevent her from feeding properly and may mean she doesn’t empty your breast fully.
You could have an oversupply of milk. Mums who produce an abundance of milk will be used to engorged, leaky breasts but oversupply can also lead to blocked ducts as it becomes more difficult for your baby to drain your breasts completely.
Infection. You are more susceptible to infection if you have cracked nipples or if your immune system has been compromised by another illness.
Pressure on your breasts such as an ill-fitting bra or tight clothing can reduce the flow of milk. Lying on your front for long periods of time can also affect milk flow.