Mastitis: Updated Guidelines on Treating the Boob Flu

Mastitis. The boob flu. Hell on earth.

Until recently, mastitis wasn't that well understood, but thanks to research completed by the Academy of Breastfeeding Medicine, we now know just how nuanced this condition really is - and how wrong most of our old treatment recommendations were.

What is mastitis?

Mastitis a blanket term that encompasses a "spectrum of conditions" resulting from what is essentially swollen tissues and ducts in a lactating breast.

There is both inflammatory mastitis and bacterial mastitis, which require slightly different treatments. When left untreated, inflammatory mastitis can lead to bacterial mastitis.

Oversupply, inflammation of tissues or ducts, dysbiosis (an imbalance in good and bad bacteria in your milk), and bacterial infection can all contribute to a lactating person developing mastitis. While most cases are mild, extreme cases can go south pretty quickly and land you in the hospital with a serious infection.

Symptoms

Swelling, pain and tenderness in one breast.
Red streaks radiating out from affected area or a wedge-shaped red area.
Flu-like aches and chills.
Fever above 101.
Generally feeling like death might be a slight improvement. Or as a friend put it, “time to amputate my boob with a dull knife. It’ll feel better than this.”

Wait, do plugged ducts caused mastitis?

Plugged ducts (now more aptly named "ductal narrowings") definitely play a roll, but new research suggests it's often the one-two punch of inflammation and oversupply that really sets the mastitis wheels in motion.

How do I know if I have a plugged duct or mastitis?

Typically you won't have the flu-like symptoms or fever that can accompany mastitis, but if you have any questions, you should be sure to call your care provider. Symptoms of a ductal narrowing include:

Sharp pain in a specific area of the breast or nipple
Mild redness, but no streaking
Possible reduced flow of milk
A tender lump in the breast or nipple
Milk blebs on your nipple

While ductal narrowings aren't as medically urgent as mastitis, they can be very painful and knowing how to properly treat them can reduce your chances at developing mastitis.

What you can do at home for mastitis and ductal narrowing

Most mastitis symptoms can improve with minimal treatment, so no need to panic if you just went 5/5 with our list of symptoms. Research shows with quick and appropriate care, you can fight the boob flu without much intervention.

Rest Try your best to lay as low as possible to give your body a shot at righting the ship.
Fluids When aren’t fluids the answer?
Reduce inflammation NSAIDs (non-steroidal anti-inflammatories) and/or acetaminophen to reduce fever, pain, and inflammation.
Nurse on demand Don't overfeed in an attempt to "empty" the breast as this will further inflame tissues and add to your issues. (This is a big change from old recommendations.)
And while we're on the subject, try to nurse rather than pump to maximize milk removal and prevent trauma to delicate tissues from ill-fitting flanges and suction strength.
Use ice to reduce inflammation (previous recommendations were to apply heat, which might feel good but draws more fluid to already inflammed areas perpetuating the problem.)
Gentle lymphatic massage from the nipple towards the armpit. Basically just "sweep" the skin from your nipple towards your armpit so your lymphatic system can do what it does and rid your body of the excess fluid.
Wear a well-fitting bra (or none at all if you'd rather)
Leave your nipple alone Don't pop your nipple blebs since it will just increase the inflammation and cause more problems.
Sunflower or soy lecithin 5-10mg daily by mouth may help reduce ductal inflammation and emusify milk
Treat chronic hyperlactation you'll need to talk to a medical professional about this one, but give them a jingle if you think you're dealing with this.

What healthcare providers are no longer recommending to treat mastitis or plugged ducts (ductal narrowing):

Dangle feeding, hand expressing, deep massage, using an electric toothbrush or anything else that vibrates, and heat are all no-nos now – basically anything that causes further inflammation. This study also cautioned against using saline or epsom salt soaks (they can "macerate" skin), and castor oil compresses, which previously had been suggested as potentially helpful home remedies.

When to see a health care provider

If you have any doubt or concerns, call your provider. Here are some things to be mindful of.

You have a history of mastitis.
Your fever or pain are rising quickly or if they are not resolving after 24 hours.
You feel extremely sick.

After effects

You may see a temporary drop in production on the affected side.
Your breast may ache or have some bruising.
If you are on antibiotics, make sure to take plenty of probiotics to help ward off thrush. Because that’s the last thing you need.
New research has linked mastitis with PPD, so long-run, keep that on your radar.

Prevention

With many small factors combining to increase your chances for mastitis, the best prevention for the average bear is knowing what to look out for so you can nip it in the bud if it kicks up. If you find you're having repeated cases, it's worth a longer chat with your health care provider or lactation consultant so the underlying cause can be identified and treated.

Mastitis is no fun.

So if you’re feeling flu’ish and run down (well, extra flu’ish and more run down than a new mother normally does) along with breast pain, that may be where your troubles are coming from.