In the past, recommendations for treating mastitis included advice like using heat and firm massage, in addition to increasing the frequency of breastfeeding or pumping sessions.
As we understand more about mastitis, we now know that these techniques could actually exacerbate the problem.
In the past, mastitis was thought of as a single condition in the breast that was caused by milk stasis. We now know that Mastitis comes from inflammation in the breast. There are a spectrum of conditions resulting from inflammation in the breast, ranging from engorgement and blocked ducts to acute bacterial mastitis and breast abscess. There are also a spectrum of contributing factors to mastitis, such as genetics, medical conditions, birth circumstances and breast pump use.
Techniques such as heat, massage, and increased milk removal do not work to treat inflammation. Think of the basic advice on how to treat inflammation in other areas of the body – it’s commonly ice, anti inflammatory medications, and rest. This is similar to the techniques recommended for the treatment inflammatory mastitis.
In 2022, The Academy of Breastfeeding Medicine revised the protocol on treating Mastitis. Here is a brief summary of how the new protocol has changed the advice we give for treating mastitis.
Old advice:
Use heat packs on the breasts between feeds to help clear blocked ducts and increase milk flow.
New advice:
Use heat sparingly before breastfeeding or pumping to help encourage the milk to let down. Use ice or cold packs after feeding or between feeds to help reduce inflammation. There is no scientific evidence to suggest that cold cabbage leaves are more effective than regular ice packs.
Old advice:
Firmly massage the breast towards the nipple to help unclog blocked ducts.
New advice:
Gently massage the breast away from the nipple to encourage lymphatic drainage of inflammatory fluids. Using firm massage can cause capillary damage and increase inflammation. The level of pressure used should be similar to the pressure used when patting a kitten.
Old advice:
Increase the frequency of breastfeeds or pumping sessions to help clear mastitis from the breast.
New advice:
Stick to your regular feeding or pumping routine. Increasing milk removal by breastfeeding or pumping more often than usual can increase milk supply and exacerbate existing inflammation.
Old advice:
Begin antibiotic treatment at the onset of mastitis symptoms.
New advice:
Antibiotics do not work to treat inflammatory mastitis and should only be used if there is an infection. Without the presence of an infection, antibiotics may contribute to bacterial dysbiosis. Signs that inflammatory mastitis has progressed to an infection can include fever, nausea, heat and/or red streaks on the breast, or any symptoms that are not improving or are getting worse within a 24 hour period.
Probiotics may help to increase good bacteria in the breast and avoid recurrent mastitis. Inflammation and pain can both be treated with over the counter medications.
Something that has remained over time is the advice for mothers with mastitis to rest. Identifying ways to decrease stress and increase opportunities for rest are important measures in treating mastitis.
Remember, if symptoms of mastitis persist or worsen beyond 24 hours, seek advice from your healthcare provider.
