Mastitis is due to an infection (almost always due to bacteria rather
than other types of germs) that usually occurs in breastfeeding
mothers. However it can occur in any woman, even if she is not
breastfeeding and can even occur in newborn babies of either sex.
Nobody knows exactly why some women get mastitis and others do not.
Bacteria may enter the breast through a crack or sore in the nipple but
women without sore nipples also get mastitis and most women with cracks
or sores do not.
Mastitis is different from a blocked duct because a blocked duct is not
thought to be an infection and thus does not need to be treated with
antibiotics. With a blocked duct, a mother has a painful, swollen, firm
mass in the breast. The skin overlying the blocked duct is often red,
but less intensely red than the redness of mastitis. Unlike mastitis, a
blocked duct is not usually associated with fever,
though it can be.
Mastitis is usually more painful than a blocked duct, but both can be
quite painful. Thus seeing the difference between a “mild” mastitis and
a “severe” blocked duct may not be easy. It is also possible that a
blocked duct goes on to become mastitis, so things become even more
complicated. However, without a lump in the breast, there is
mastitis or blocked duct for that matter. In France,
recognize something they call lymphangite when the mother has a
painful, hot redness of the skin of the breast, associated with fever,
but there is no painful lump in the breast. Apparently, most do not
believe this lymphangite requires treatment with antibiotics. I have
seen a few cases that fit this description and yes, in fact, the
problem goes away without the mother taking antibiotics. But then,
often a full-blown mastitis also goes away without the mother taking
As with almost all breastfeeding problems, a poor latch, and thus, poor
emptying of the breast sets the mother up for blocked ducts and
Blocked ducts will almost always resolve without special treatment
within 24 to 48 hours after starting. During the time the block is
present, the baby may be fussy when breastfeeding on that side because
the milk flow will be slower than usual. This is probably due to
pressure from the lump collapsing other ducts. A blocked duct can be
made to resolve more quickly if you:
- Continue breastfeeding on that side and draining
This can be done by:
- Getting the best latch possible (see
Latching as well as the video clips on how to latch a baby on
- Using compression to keep the milk flowing
sheet Breast Compression as the video clips on how
to latch a baby on
at the website nbci.ca). Get your hand around the blocked duct
and compress it as the baby is breastfeeding if it is not too painful
to do so.
- Feeds the baby in such a position that the
the blocked duct. Thus, if the blocked duct is in the bottom
area of the breast (7 o’clock), then feeding the baby in the football
position may be helpful.
- Apply heat to the affected area. You can
do this with a
or hot water bottle, but be careful not to burn your skin by using too
much heat for too long a period of time.
- Try to rest. Of course, with a new baby
it is not always
rest. Try going to bed. Take your baby with you into bed and breastfeed
A bleb or blister
Sometimes, but not always by any means, a blocked duct is associated
with a bleb or blister on the end of the nipple. A flat patch of white
on the nipple is not a bleb or blister. If there is no painful lump in
the breast, it is confusing to call a bleb or blister on the nipple a
blocked duct. A bleb or blister is, usually, painful and is one cause
of nipple pain that comes on later than the first few days. Some
mothers get blisters in the first few days due to a poor latch. Nobody
knows why a mother would suddenly get a bleb or blister out of the blue
several weeks after the baby is born.
A blister is often present without the mother having a blocked duct.
If the blister is quite painful (it usually is), it is helpful to open
it, as this should give you some relief from the pain. You can open it
yourself, but do this one time only. However, if you need to repeat the
process, or if you cannot bring yourself to do it yourself, it is best
to go to see your doctor or come to our clinic.
Once you have punctured the bleb or blister, start applying the "all purpose
nipple ointment" after each feed for a week or so. The reason for this is to
prevent infection and also to decrease the risk of the bleb or blister
returning. See the information sheet All Purpose Nipple Ointment (APNO).
You need a prescription for the ointment
- Flame a sewing needle or pin, let it cool off,
and puncture the
- Do not dig around; just pop the top or side of the blister.
- Try squeezing just behind the blister; you might be able to
out some toothpaste-like material through the now opened blister. If
you have a blocked duct at the same time as the blister, this might
result in the duct unblocking. Putting the baby to the breast may also
result in the baby unblocking the duct.
Ultrasound for blocked ducts
Most blocked ducts will be gone within about 48 hours. If your blocked
duct has not gone by 48 hours or so, therapeutic ultrasound often
works. Most local physiotherapy or sports medicine clinics can do this
for you. However, very few are aware of this use of ultrasound to treat
blocked ducts. An ultrasound therapist with experience in this
technique has more successful results.
Some mothers have used the flat end of an electric toothbrush to give
themselves “ultrasound” treatment. And apparently have had good
If two treatments on two consecutive days have not helped resolve the
blocked duct, there is no point in getting more treatments. Your
blocked duct should be re-evaluated by your doctor or at our clinic.
Usually, however, one treatment is all that is necessary. Ultrasound
may also prevent recurrent blocked ducts that occur always in the same
part of the breast.
The dose of ultrasound is 2 watts/cm² continuous for five
the affected area, once daily for up to two treatments.
Lecithin is a food supplement that seems to help
some mothers prevent
blocked ducts. It may do this by decreasing the viscosity (stickiness)
of the milk by increasing the percentage of polyunsaturated fatty acids
in the milk. It is safe to take, relatively inexpensive, and seems to
work in at least some mothers. The dose is 1200 mg four times a day.
If you start getting symptoms of mastitis (painful lump in the breast,
redness and pain of the breast, fever), try to get some rest. Go to bed
and take the baby with you so you can continue breastfeeding while
remaining in bed. Rest is good to help fight off infection.
Continue breastfeeding on the affected side. It should go
saying that you should continue on the other breast as well.
if you are in so much pain that you cannot put the baby to the affected
breast, continue on the other side and as soon as your breast is less
painful put the baby to the breast with the mastitis. Sometimes
expressing your milk may be less painful, but not always, so if you
can, continue breastfeeding on the affected side. Mothers and babies
share all their germs.
Heat helps fight off infection. It also may help
with draining of the
breast. Use a hot water bottle or heating pad but be careful not to
burn the skin.
Fever helps fight off infection. Adults usually
feel terrible when they
have a fever and you may want to bring down the fever for this reason.
But you don’t need to bring down the fever just because it’s there.
Fever does not cause the milk to go bad!
Potatoes (adapted from Bridget Lynch, RM, Community
Toronto). Within the first 24 hours of your symptoms beginning, you may
find that applying slices of raw potato to the breast will reduce the
pain, swelling, and redness of mastitis.
- Cut 6 to 8 washed raw potatoes lengthwise into thin slices.
- Place in a large bowl of water at room temperature and
leave for 15
to 20 minutes.
- Apply the wet potato slices to the affected area of the
leave for 15 to 20 minutes.
- Remove and discard after 15 to 20 minutes and apply new
- Repeat this process two more times so that you have applied
slices 3 times in an hour.
- Take a break for 20 or 30 minutes and then repeat the
Mastitis and Antibiotics
Generally, it is better to avoid antibiotics if possible since mastitis
may improve all on its own and antibiotics may result in your getting a
Candida (yeast, thrush) infection of the nipples and/or breast. Our
approach is as follows:
If you have had symptoms consistent with mastitis for less
hours, we would give you a prescription for an antibiotic,
you wait before starting to take the medication.
If you have had symptoms consistent with mastitis for more 24
the symptoms have not improved, you should start the antibiotics
- • If, over the next 8 to 12 hours, your symptoms
are worsening (more
pain, more spreading of the redness or enlarging of the painful lump),
start the antibiotics.
- • If over the next 24 hours, your symptoms are
not worse but not
better, start the antibiotics.
- • If over the next 24 hours, your symptoms are
lessening, then they
will almost always continue to lessen and disappear without your
needing to take the antibiotics. In this case, the symptoms will
continue to lessen and will have disappeared over the next 2 to 7
days. Fever is often gone by 24 hours, the pain within 24 to 72 hours
and the breast lump disappears over the next 5 to 7 days. Occasionally
the lump takes longer than 7 days to disappear completely, but as long
as it’s getting small, this is a good thing.
If you are going to take an antibiotic, you need to take the right one.
Amoxicillin, plain penicillin and some other antibiotics used
frequently for mastitis do not kill the bacterium that almost always
causes mastitis (Staphylococcus aureus). Some
antibiotics which kill
Staphylococcus aureus include: cephalexin (our usual
cloxacillin, dicloxacillin, flucloxacillin, amoxicillin combined with
clavulinic acid, clindamycin and ciprofloxacin. Antibiotics that can be
used for community acquired methicillin-resistant Staphylococcus
(CA-MRSA): cotrimoxazole and tetracycline.
All these antibiotics can be used when mothers are
breastfeeding and do
not require her to interrupt breastfeeding.
You should not interrupt breastfeeding if you are infected
Indeed, breastfeeding decreases the risk of the baby getting infection.
Medication for pain/fever (ibuprofen, acetaminophen, and others) can be
helpful to get you through this. The amount that gets into the milk, as
with almost all medications, is tiny. Acetaminophen is probably less
useful than those drugs (e.g. ibuprofen) that have an anti-inflammatory
The treatment of choice now for breast abscess is no longer
have had much better results with ultrasound to locate the abscess and
a catheter inserted into the abscess to drain it. Mothers going through
this procedure do not stop breastfeeding even on the affected side, and
complete healing occurs often within a week. This procedure is done by
an intervention radiologist, not a surgeon. Ask your doctor to check
out this study: Dieter Ulitzsch, MD, Margareta K. G. Nyman,MD, Richard
A. Carlson, MD. Breast Abscess in Lactating Women: US-guided Treatment.
Radiology 2004; 232:904–909
For small abscesses, aspiration with a needle and syringe plus
antibiotics often is all that is necessary, though it may be necessary
to repeat the aspiration more than once.
A lump that isn’t going away.
If you have a lump that is not going away or not getting smaller over
more than a couple of weeks, you should be seen by a
breastfeeding-friendly physician or surgeon. You don’t have to
interrupt or stop breastfeeding to get a breast lump investigated
(ultrasound, mammogram and even biopsy do not require you to stop
breastfeeding even on the affected side). A breastfeeding friendly
surgeon will not tell you that you have to stop breastfeeding before
s/he can do tests to investigate a breast lump.
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
Blocked duct and mastitis, February 2009©
Written and revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005©
Revised by Jack Newman MD, FRCPC and Edith Kernerman, IBCLC, 2008, 2009©