A common complication of breastfeeding, mastitis is inflammation of the breast due to milk stasis. It can be non-infectious or infectious. In addition to optimal drainage of the breast with frequent feedings, it requires, in case of infection, antibiotic treatment.

Who is affected by mastitis?

Affecting up to 20% of breastfeeding mothers, mastitis is a common complication of breastfeeding. It occurs most frequently in the first six months of breastfeeding, with the first 6-8 weeks being the most at risk. But it can also occur later, when breastfeeding is well established and everything seems to be fine. 

How does mastitis manifest itself?

Mastitis is generally unilateral: it affects only one breast (unlike engorgement which most frequently affects both). Mastitis is caused by milk stasis: breast milk is not properly evacuated, so it stagnates in the breast. This creates local inflammation in the mammary glands (the factories that produce breast milk) and / or the milk ducts (the ducts that allow the evacuation of milk). 

Contrary to popular belief, mastitis is therefore not necessarily linked to an infection. But if the inflammation persists, it is possible that it progresses to a bacterial infection. A distinction is thus made between non-infectious mastitis and infectious mastitis. The most common germ involved in infectious mastitis is the Staphylococcus aureus, less frequently streptococcus or Escherichia coli.

The inflammation manifests as a painful lump in the breast, accompanied by a hot, red, and sometimes swollen area on the breast, pain, and a feeling of warmth. Milk production may decrease in the affected breast, as local inflammation and edema affect the functioning of the milk-secreting cells.

The baby may also be reluctant to suck on the affected breast, as breast milk may taste a little more salty than usual due to the inflammatory phenomenon.

Causes of mastitis

Anything that prevents milk from flowing properly can lead to milk stasis, and therefore mastitis. In practice, this covers a large number of situations:

Poor latch

It causes inefficient suction. This sucking problem can itself have different causes: a bad position of the baby at the breast, a too short tongue frenulum, the use of silicone breast tips (which make sucking less effective).

Less frequent feedings

Which induce too long an interval between feedings, for example due to a baby’s breastfeeding strike, a baby who is sleeping through the night, returning to work, weaning too quickly, use pacifier and / or bottle.

Strong milk production

It then makes effective drainage of the breast difficult.

A barrier

The good flow of milk (due to a too tight bra for example). Clogged milk ducts or engorgement can lead to mastitis if not properly managed with effective drainage.

What elements favor the appearance of mastitis?

Other elements, without being the direct cause of mastitis, can constitute a favorable ground for its appearance:

• a great fatigue in the mother, a state of stress or significant anxiety;
• an unbalanced diet;
• the presence of crevices, the gateway to bacteria;
• certain maternal illnesses such as diabetes or anemia;
• antibiotic treatment;
• a yeast infection;
• a history of breast engorgement, mastitis, blocked milk ducts.

Some symptoms suggest the presence of an infection:

• fever ;
• severe fatigue, chills, body aches (as in a flu-like state);
• nausea (with or without vomiting);
• a “cupboard” on the immediately very red, hot and painful breast.

It is therefore advisable to consult your doctor or midwife as soon as possible in order to treat the infection.

First of all, let us specify that mastitis does not sign in any way the cessation of breastfeeding, quite the contrary since its management passes, in part, by emptying the breast thanks to frequent feedings, if however the pain permits. The milk is not infected and the fever has no impact on its composition. The baby therefore runs no risk to drink the mother’s milk.

Two types of mastitis

Next, it is important to differentiate between two scenarios. 

Beginner mastitis

Faced with early mastitis (symptoms that appeared less than 12 hours ago), without any sign of infection (no fever or deterioration in general condition, only slight inflammation), the priority will be to drain the breast effectively in order to to decrease the milky stasis. And for that the most effective remains the baby, with a very frequent breastfeeding, by respecting these precautions:

• make sure you have a good position for a good latch and effective sucking. Certain breastfeeding positions, such as Biological Nurturing or Inverted Madonna, are particularly effective in properly draining the breast. Do not hesitate to call on a lactation consultant (IBCLC approved) in order to get help for optimum latching;
• breastfeed very frequently, on demand and without time limit;
• during feeding, to promote emptying of the engorged part of the breast, place the baby so that he rests with his chin on the red area of ​​the breast. Another solution: massage this area with your finger, from the outside of the breast towards the nipple;
• to finish draining the breast, complete if necessary with manual expression of milk or with a breast pump (making sure to use a gentle suction mode)

At the same time, the mother must rest, because the fatigue factor plays a large part in the appearance and resolution of mastitis. Anti-inflammatory pain relievers compatible with breastfeeding (paracetamol, ibuprofen) may be prescribed to reduce the pain. 

Severe mastitis

If the symptoms are severe from the outset with signs of infection (fever, deterioration of the general condition), if they are accompanied by deep cracks, if they persist after 24 hours of optimum drainage or if both breasts are affected, antibiotic treatment is necessary in order to treat the infection.

If not taken care of, it can indeed progress to a breast abscess (a localized accumulation of pus in the breast). It is usually not necessary to have breast milk tested in order to find the causative germ. To treat the spectrum of the most frequently incriminated germs, different antibiotics can be used (combination Amoxicillin / Clavulanate, Cloxacillin, Oxacillin, Cefazolin Cefalexin, Cefadroxil, Clindamycin).

If the mastitis is caused by the methicillin-resistant Staphylococcus aureus (MRSA) germ, then several antibiotics will be needed. In case of penicillin allergy, other antibiotics will be prescribed. Safe for the baby, these antibiotics are compatible with continued breastfeeding.

It is even strongly recommended to continue it for a good drainage of the milk. The baby thus continues to benefit from the nutritional benefits of milk, in particular for the immune system. It is important to take the treatment for the duration indicated (usually 7 to 14 days) even if improvement occurs quickly. 

In some cases, a new consultation and laboratory analyzes may be necessary:

• if a previous antibiotic treatment has had no effect;
• in case of recurrent mastitis.

It will then be necessary to rule out bacterial resistance, the presence of an abscess or any other breast problem.

Along with optimal breast drainage through frequent feedings, and in the absence of serious signs of infection, certain natural remedies can be used to relieve pain:

• perform a manual, gentle, circular breast massage with the palm of the hand on the affected area;
• apply warm compresses before feeding and even during, to facilitate the ejection reflex, then cold compresses outside of feedings, to relieve pain.

Various studies have shown the effectiveness of probiotics, and more specifically of the strains Lactobacillus salivarius CECT5713 and Lactobacillus gasseri CECT5714, in the treatment but also in the prevention of mastitis.

Mastitis could indeed have a link with an imbalance of the mammary microbiota, especially if they tend to recur. Alone or in combination with antibiotic therapy, three weeks of antibiotic treatment would contribute to a better resolution of symptoms and a reduced risk of recurrence.

A good latch and breastfeeding on demand are the two essential points to avoid mastitis, and in general, for breastfeeding to go as well as possible. If a bad position is the cause of ineffective sucking and / or crevice, it should be corrected, if possible with the help of a lactation professional. If the presence of a tongue frenulum in the baby is the cause of poor sucking, a brakeotomy may be considered. 

Rest and a balanced diet are also important for a mother to be in good shape. Despite everything, mastitis sometimes occurs despite these precautions.