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29 Facts You Probably Don’t Know About Mastitis

Woman with hands over breast area.

Maybe you already know the common signs and symptoms of mastitis. But you’ll be better off if you know more — including these 29 often overlooked facts.

Know who gets mastitis?

Anyone can get mastitis. And some women are at higher risk than others. Be aware that women who are most likely to get mastitis:

  • are breastfeeding, but it can occur even after weaning — sometimes, several years after
  • are breastfeeding their second, third, or fourth child (as opposed to first-time breastfeeders)
  • have twins — because of such a big milk supply
  • are diabetic — because diabetics are always at higher risk for infections
  • have already had one episode of mastitis — they are more vulnerable to having another episode

Know the misconceptions, misdiagnoses related to mastitis?

Although mastitis is not uncommon, some misconceptions lead to misdiagnosis, overtreatment, or under-treatment. Do not to overlook:

  • how the case was diagnosed. Most cases are diagnosed over the phone. That increases the possibility of misdiagnosis.
  • whether cultures of the milk were obtained. Most often, no cultures were obtained. Therefore, the treatment sometimes is not well-matched to the particular infection.
  • that a false negative result can occur, even when the milk is cultured. Why so? If tested milk comes from an unaffected duct, the culture will come back negative.
  • that mastitis can occur in both breasts, although that is highly unlikely.
  • mastitis is usually due to Staphylococcus aureus, or Streptococcus. However, a new strain of staph has been discovered,  Staphylococcus lactarius.
  • infection may not be present. Remember that mastitis is an inflammation of the breast, with or without infection.

Know which signs, symptoms require quick actions

I listed the common signs and symptoms and course of the condition in an episode of “Born to be Breastfed.” 

However, there are a few signs and symptoms that often go unnoticed or unreported. Pay attention to:

  • mild cases, or those with symptoms for less than 12-24 hours; these do not necessarily need treatment with antibiotics.
  • a plugged duct. It’s a classic warning sign of mastitis, but sometimes there is no such warning.
  • any signs and symptoms, whether they come on suddenly, or gradually. Some mothers can go to bed feeling well, and suddenly wake up with a high fever a few hours later.

Know the usual treatments for mastitis?

Treatment is fairly common around the globe. Here are the most common treatments:

  • The most commonly-prescribed drugs for mastitis include dicloxacillin, flucloxacillin, cloxacillin, amoxycillin, or cephalexin. If your client is allergic to these penicillin-related drugs, then it’s likely erythromycin will be prescribed. If the mastitis is due to a methicillin-resistant Staphylococcus aureus, then clindamycin, ciprofloxacin, nafcillin is likely to be prescribed.
  • The most commonly-prescribed drugs for the treatment of mastitis are generally recognized to be compatible with breastfeeding.
  • Although there is no clear evidence to substantiate it, experts and authorities agree that a treatment regimen of less than 500 mg for fewer than 10-14 days is likely to be insufficient.

Know when to call for medical help

Sure, you know the common signs and symptoms.  But the presence of unusual or quick-onset signs and symptoms need very immediate medical attention:

  • a sudden fever comes on 38.5°C (101.3°F)
  • blood or pus is in the milk
  • symptoms are severe, or present in both breasts
  • red streaking is on the skin of the breast
  • symptoms develop before 2 weeks after birth
  • if aches, and pains and related signs and symptoms don’t subside within 24 hours after antibiotic therapy has been started; the prescribed antibiotic therapy might not be the one that adequately covers the exact germ causing the infection.

Know what about continuation of breastfeeding

Some women believe or were told that they need to discontinue breastfeeding. Au contraire! Get this:

  • Weaning “cold turkey” is the worst thing to do during an episode of mastitis! The milk backs up and makes the condition worse.
  • Milk volume may decrease in the affected breast, but it will return to normal after treatment.
  • Milk from the affected side might look stringy. It’s safe for the baby, it just looks odd.

Know that after treating mastitis … then what?

With and without successful treatment, be aware that:

  • redness or tenderness can continue for about a week, even if the infection has been successfully treated.
  • Candidiasis (thrush) can result from antibiotic therapy, and it may occur later. Its treatment is different, and you should not mistake the signs and symptoms as another bout of mastitis.
  • An unresolved episode of mastitis can lead to a breast abscess, which is very serious and requires special treatment and, in extreme cases, temporary cessation of breastfeeding on the affected side.

This isn’t everything you need to know about mastitis. If you are a professional, you’ll want to see many more important details in this Workbook. Remember, like other breastfeeding problems, mastitis is temporary and solvable.

Which of these facts about mastitis surprised you most? Tell me in the comments below!

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  1. Andrea

    I developed mastitis once my baby started sleeping through the night – after two nights of wonderful rest, I quickly realized that I couldn’t sleep through the night and needed to pump at 3am…. I wish there was a better solution, but I have yet to come up with one – any suggestions are more than welcome!

  2. Marie

    No easy answer on this one! I’m guessing this happened when your baby had a rather abrupt shift into a long stretch of sleep at night. (It’s less likely to happen when babies move gradually towards the longer stretches.)

    There’s a few things you can consider. The first thing might be, what is your sleep position? Try not to sleep on your belly, or even in some position that puts pressure on your breast. You could try taking some lecithin; that might help. (But are you allergic to soy?) This can help to make the milk less viscous. Another thing–try warm compresses on your breasts before going to bed. It can help the bring circulation to the area.

    Are you getting enough Vitamin C? So often, we end up with some issue and we point to an external source e.g., baby is sleeping through the night. But remember that internal factors are in play, and good nutrition is a vital part of staying healthy.

    None of these ideas are a magic bullet, but some or all might be worth a try.

  3. Debra

    You state: “If the mastitis is due to a methicillin antibiotic, then clindamycin, ciprofloxacin, nafcillin is prescribed.” How would use of an antibiotic cause mastitis?

    • Marie Biancuzzo

      Whoa! You caught me! I was typing too fast. I mean to say, “If the mastitis is due to a methicillin-resistant Staphylococcus aureus…” I made the edit. Thank you for bringing it to my attention.

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