If you have found this blog you probably already know that mastitis causes pain, and discomfort, and can potentially impact your breastfeeding journey.

But did you know that new research has shown us that some of the common advice that is being given for preventing and treating mastitis might be making things worse?

For those of you who have read my other blogs, you will see this is a recurring theme in birth and babies 🤦🏻‍♀️

It is so important for those who are involved with supporting breastfeeding to keep up with the latest research and be prepared to change their practice when needed.

Understanding Mastitis

 

We have been led to think that mastitis means “infection”.

However, mastitis is an inflammatory condition of the breast, which in some rare cases may lead to an infection. It is not an infection of the breast tissue causing inflammation.

What causes mastitis?

We used to think that mastitis was caused by “block/plugged ducts” or “milk status”, but no scientific evidence has been found to support this theory.

In fact:

“Ducts in the breast are innumerable and interlacing (Figs. 6–8), and it is not physiologically or anatomically possible for a single duct to become obstructed with a macroscopic milk ‘‘plug’’.” (ABM Protocol #36, 2022)

There is also little evidence to support the long-held belief that mastitis is caused by the spread of bacteria from a damaged nipple or thrush (ABM Protocol #36, 2022).

Most likely, what is causing mastitis is poor fit and hold (latch and attachment) causing breast tissue drag; positional instability, causing breast tissue drag; ineffective milk transfer; skipping feeds; pumping; tight bras and inflexible nipple shells.

There is also a possibility that “Mammary dysbiosis”, or disruption of the milk microbiome, contributes to mastitis. This may be caused by genetics, medical conditions, use of antibiotics, regular use of breast pumps, and caesarean births (ABM Protocol #36, 2022). However, we possibly don’t know enough about the normal human milk and breast tissue microbiome yet to fully understand this (Douglas, 2023).

It can be confusing because inflammatory mastitis can cause systemic symptoms like fever, chills, and a fast heart rate, which are similar symptoms of an infection.

But the clue was always in the name mastitis 

“Itis” means inflammation.

We need to get back to thinking about inflammation, not infection, when preventing and treating mastitis.

Most cases can be resolved quite quickly by treating what is causing the inflammation.

If you suspect mastitis, contact a lactation consultant to resolve the issue causing inflammation.  Then, if symptoms persist, consult your health professional.

 

 

Preventing Mastitis

 

Avoid Deep Breast Tissue Massage.

I have been finding that women are still being told to deeply massage their breasts to prevent mastitis very soon after birth. This can cause more swelling, inflammation, and damage to blood vessels and can trigger inflammatory mastitis, so we need to stop this outdated advice.

It is important to know that breasts can get lumpy, and this is normal.  Deeply massaging these normal lumps may lead to mastitis!

Breasts can get engorged in the first few days when your milk comes in. Deeply massaging engorgement can worsen the inflammation and lead to mastitis.

Some ways of preventing postpartum engorgement are:

• Minimise intravenous fluids during labour, as this fluid can accumulate in the breast tissues and exacerbate swelling and engorgement.
• Frequent and flexible, physiological breastfeeding (at least 10 feeds in 24 hours.
• Use gentle hand expression to relieve symptoms and provide breast milk/colostrum if your baby is not transferring milk effectively or you are separated from them.
• Perform reverse-pressure softening of the areola.

 

Avoid  Breast Tissue Drag

Poor fit and hold (latch and attachment) can cause breast tissue drag which can lead to pain, and the breast tissue becomes inflamed.

There has also been a lot of research into the biomechanics of breastfeeding. Unfortunately, some healthcare professionals are still using the 1840s understanding of breastfeeding and a lot of advice works against the actual biomechanics, causing damage and inflammation. (My blog, Breastfeeding 101 explains this in more detail.)

Helping my clients understand, and work with, the biomechanics is making a huge difference in reducing breast tissue drag and pain with feeding. I

 

Avoid Too Much Pumping.

I have to admit that I am a bit shocked by the number of women pumping early in their breastfeeding journey. So many are on the “triple feeding merry-go-round”, thinking this is needed to improve their milk supply.

With frequent and flexible feeding, good fit and hold techniques, and efficient milk transfers, your baby is your best “pump” to ensure good milk production. Trust yourself and your baby.

Many women are also using devices to capture milk during feeding, such as the Haaka. It is important to know that such devices are not passively collecting milk. They work by suction and can extract more milk than would be released during a letdown. These devices can also get in the way of positional stability which leads to poor fit and hold, which leads to breast tissue damage, which leads to inflammation and mastitis. Are you seeing a pattern my point?

Some other ways unnecessary pumping could potentially impact are:

• Early mechanical breast pumps make the breasts make more milk the baby wants to take, meaning an oversupply is created which then needs to be carefully managed to prevent inflammation and mastitis.
• Pumping doesn’t let germs move from the baby’s mouth to the mother’s breast, it may make dysbiosis (disruption of the milk microbiome more likely.
• The wrong flange size, the force being too high, or the mother pumping for too long can damage the breast glandular tissue and the nipple-areolar complex, increasing the risk of inflammation and mastitis.

When women need to use a breast pump, they should express milk at a rate and amount that are similar to how their babies would naturally do it.

 

Avoid Milk Duct Compression

Your bra may feel loose when you put it on breasts that have just fed your baby, but as your breasts fill, your bra can compress the milk ducts and cause inflammation. This can also happen with hard breast shells such as Silverettes.

We now know that the ducts are close to the skin surface, making them easily compressible (Ramsay et al, 2005). This is why it is important to be careful with tight bras and clothing, hard breast shells/silver caps, and even seat belts.

Wearing well-fitted bras can help; just make sure they don’t become too tight as your breasts fill.

 

 

 

 

 

 

 

 

 

REFERENCES

Douglas, P. Does the Academy of Breastfeeding Medicine’s Clinical Protocol #36 ‘The Mastitis Spectrum’ promote overtreatment and risk worsened outcomes for breastfeeding families? Commentary. Int Breastfeed J 18, 51 (2023). https://doi.org/10.1186/s13006-023-00588-8

Mitchell KB, Johnson HM, Rodríguez JM, Eglash A, Scherzinger C, Zakarija-Grkovic I, Cash KW, Berens P, Miller B; Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med. 2022 May;17(5):360-376. doi: 10.1089/bfm.2022.29207.kbm. Erratum in: Breastfeed Med. 2022 Nov;17(11):977-978. doi: 10.1089/bfm.2022.29207.kbm.correx. PMID: 35576513.

Ramsay DT, Kent JC, Hartmann RA, Hartmann PE. Anatomy of the lactating human breast redefined with ultrasound imaging. J Anat. 2005 Jun;206(6):525-34. doi: 10.1111/j.1469-7580.2005.00417.x. PMID: 15960763; PMCID: PMC1571528.