Evidence-based treatment for inflammatory mastitis, and why physiotherapy is now part of modern breastfeeding care.
The Short Answer
Breast pain, swelling, patches of hardness, and possibly redness during breastfeeding are caused by inflammatory mastitis. This is a local inflammatory reaction and not an infection. Therefore, in many cases, anti-biotics are not the first treatment required. Early physiotherapy can reduce inflammation with specific treatment, thereby relieving pain and improving milk flow to support continued breastfeeding. This reduces the risk of an infection setting in.
What is Non-purulent Mastitis?
This is an inflammatory condition of the breast that commonly occurs with breastfeeding.
Thinking of it as a blocked milk duct is not entirely accurate. Current research describes mastitis as a spectrum of inflammation. This is how it happens:
Milk may not drain effectively from an area of the breast. This can be because of poor latching, oversupply, engorgement, infrequent feeds, or external pressure – like a flange of a breast pump that is too small.
This retained milk causes increased pressure within the milk ducts, stretching the walls and allowing milk to leak out into the breast tissue. Milk is not meant to be in the breast tissue. The immune system recognises the milk molecules as a signal of tissue injury, and a sterile (not bacterial) inflammatory response is triggered.
Inflammation causes swelling, redness and pain. The swelling in the breast tissue further compresses the milk ducts, making milk drainage even more difficult.
This creates a vicious and painful cycle.
Mastitis is not caused by a blocked duct that needs to be massaged out.
Current research shows that aggressive massage may actually cause tissue damage and worsen the inflammation.
Signs and Symptoms of Mastitis
You may notice
- a painful area of the breast
- redness over part of the breast
- swelling or hardness
- warmth
- tenderness during feeds
As the inflammation becomes more severe, or if a bacterial infection develops, you may also notice
- fever
- chills or flu-like symptoms
- feeling generally unwell
- increasing breast pain
What You Can do at Home for Mastitis
Early management aims to calm the inflammation.
Current recommendations include the following:
- continue breastfeeding
- optimise baby’s positioning or latching
- wear a supportive but non-restrictive bra
- apply coolness after feeding to reduce swelling
- stay hydrated
- rest whenever possible
What should be avoided?
Many traditional recommendations are now known to delay recovery. Avoid deep massage attempting to ‘break up the lumps’ and force the blockage out. Avoid pumping excessively to try to empty the breast as much as possible, and avoid prolonged heat like a hot shower. Be aware of taking anti-biotics unnecessarily in the absence of a bacterial infection.
How Can a Physiotherapist Help?
A Women’s Health physiotherapist can provide specific treatment that aims to reduce inflammation and ease pain while protecting breastfeeding.
An initial assessment will be done to identify possible contributing factors that can be addressed.
Treatment will be specific to how the mom presents on the day but will usually include the following:
- gentle lymphatic drainage
- therapeutic ultrasound
- low level laser therapy
- specific soft tissue mobilisation technique
- strategies to improve breast drainage without increasing inflammation
- posture and positioning advice
- monitoring to ensure symptoms are improving in the first 24-28 hours and referral to a doctor when progress is not satisfactory
Treatments are not painful or forceful, but rather gentle and relieving to ease pressure and inflammation.
When Should I see my Doctor Urgently?
Seek medical advice promptly if you develop increasing pain and redness despite management, a persistent high fever, pus from the nipple, or a new soft raised lump that may suggest an abscess.
Early treatment reduces the likelihood of complications.
You’re not expected to manage mastitis alone
Breastfeeding is not something we should ‘instinctively’ master on our own. It is normal for it to be challenging. It’s not normal for it to be painful.
Breastfeeding is a skill that both baby and mom need to learn, and both need to be physically able to feed. It is complex and can fail for reasons that we don’t even consider. For example, if a baby has a restriction in their neck due to their position in utero or to the birth, they may not be able to turn their neck in one direction. This can affect the position their body can assume and therefore their latch. An incorrect latch position can affect how milk drains from the breast.
Support for breastfeeding and managing mastitis is available.
