Mastitis, blocked ducts, and engorgement - La Leche League GB

Mastitis (breast inflammation), includes a wide range of symptoms, from a small, tender area (often called a blocked duct), through to severe infection.  

If your breasts are inflamed or swollen, it’s important to act quickly to relieve discomfort and stop it getting worse. You may also need to deal with any underlying causes.

LLL Leaders are here to help.

What do all these words mean? A quick guide

What are the signs of mastitis?

Why does it happen?

What can I do?

Do I need medical help?

How can I prevent mastitis in the future?

What do all these words mean? A quick guide

Mastitis just means ‘breast inflammation’. Recent research is changing how mastitis is viewed and treated. It’s now understood as a wide spectrum, from a small, tender area – often called a blocked duct – to a severe infection.

Milk blisters/blebs look like tiny white or yellow dots on the tip of the nipple. They can cause no trouble, or they might be very painful (often described as ‘stinging’ pain). Sometimes they form in one or more ‘milk pores’, blocking milk from coming out of part of the breast. They are part of the mastitis spectrum of related conditions and the self-treatment measures suggested for mastitis may help. Milk blisters that don’t block milk coming out, and don’t hurt, can be safely left alone. They eventually disappear.

Engorgement is when the whole breast becomes swollen with extra fluid. It’s common 2-5 days after birth, when milk production is increasing very fast. The mastitis self-treatment measures described below are helpful for engorged breasts, too. Treat engorgement promptly to avoid developing mastitis.

A breast abscess is a collection of pus (infection) within the breast. It is usually a complication of mastitis that was not adequately treated. An abscess needs urgent medical treatment: drainage and antibiotics. 

What are the signs of mastitis?

• One or more areas that are tender (sometimes called a blocked duct).
• Your breast might feel warmer, harder, or lumpier than usual.
• There may be a patch of skin on your breast that has changed colour (dark skin might look darker than usual, on light skin you might see a red patch). 
• You might have a fever and feel like you have the flu. Your body may respond to inflammation with an increase in temperature — it doesn’t necessarily mean you have an infection. See below, “Do I need medical help?”

Could it be a breast abscess?

Most (though not all) people with an abscess feel very ill. If you have one or more lumps in your breast that don’t get smaller as milk is removed, and don’t respond to the treatments for mastitis suggested in this article, contact your GP or NHS 111. An abscess needs urgent medical treatment. It’s usually possible — and may be preferable — to continue breastfeeding while an abscess is treated, if you want to. LLL Leaders can support you through it.

Why does it happen?

When breasts are too full of milk, or the breast is injured, your body may react with inflammation – a response to a threat. Blood flow to the area increases, and fluids and immune cells rush in to repair damage and fight off bacteria. As pressure within the breast increases, it feels tender or painful, and it may become difficult for the milk to flow easily.

Common causes of mastitis

• Issues with positioning and attachment: Your baby is not removing milk efficiently. 
• Scheduling or limiting feeds: If breasts aren’t relieved as often as they need to be, this can result in mastitis (and decreased milk production). The amount of milk breasts can hold – and how long they can comfortably hold it for – varies hugely between individuals, and changes over time.
• Oversupply: Having a lot more milk than you need. Sometimes it’s caused by ‘overpumping’. Sometimes it just happens – this is more likely with second or subsequent babies. Your baby may get upset, gag, and splutter when your milk releases. They are probably growing very fast. Your breast/s may feel uncomfortably full a lot of the time. If you’re struggling with oversupply, LLL Leaders can help.

• Suddenly removing less milk than usual: For example, because your baby is ill, sleeping longer, or you are away from your baby.
• Weaning: If you reduce the amount you breastfeed faster than your breasts can manage.

Less common causes of mastitis

• Breast injury, e.g. from a too-tight bra, bag or sling strap, breast pump, or seatbelt. Or even sleeping on your stomach.
• Bacterial infection in the breast, possibly through an open nipple wound.

Factors that may make mastitis more likely:

• Smoking
• Previous breast surgery, such as implants
• Being under a lot more stress than usual, or extremely exhausted
• Being anaemic or having other health conditions that make your immune system work less well
• Gut health. Some experts think that imbalances in the ‘microbiome’ (the bacteria that live in your body) may make some people more likely to get mastitis. The breast has its own microbiome which is affected by many factors, including your diet, antibiotic use, and whether your baby feeds direct at the breast. It’s a developing field of research.

Causes of engorgement

In the first few days after birth, you may have more engorgement if you were given extra fluids during labour and birth. But engorgement can happen at any stage of breastfeeding if there’s more milk than your breast/s can comfortably hold. For example, if: 

• your baby is unwell and feeding less than usual, or less than your breasts need
• your baby starts sleeping for a longer stretch at night
• you are away from your baby and don’t express as often as your breasts need.

My breasts are engorged, or I think I’ve got mastitis – what do I need to do?

Start treatment at the first signs of breast swelling or inflammation. It’s often possible to deal with it at home without medical help.

• Take standard doses of an over-the-counter non-steroidal anti-inflammatory medication such as ibuprofen, if you can usually take it. Paracetamol may also be helpful if you’re in pain, but ibuprofen is more useful for mastitis, because it also reduces inflammation. Both are safe to take while breastfeeding.
• Experiment with cold or cool compresses on the affected area/s between feeds, to see what helps you feel most comfortable.  Some cultures and communities advise new mothers to avoid cold in the early week after birth, and to use heat instead — if this is the case for you, see “things to avoid”, below.
• Remove milk as often as you need to, to keep the breast as comfortable as you can. Feed your baby whenever they want to be fed or continue expressing whenever you would usually express. Offer a feed or express some milk if your breast feels very full and uncomfortable.
• Rest as much as you can. Inflammation is tiring for your whole body. Those who have had mastitis often say that they got it when they were under extra stress, or busier than usual – it may be a sign that you need to slow down. Rest is an important part of healing. Taking time off work, or having a partner or support person help you care for your baby can be useful for a few days.
• Experiment with different feeding positions. This may help you be more comfortable and help to drain different areas of the breast.
• Some experts recommend taking probiotics, or the food supplement lecithin. Check with your healthcare provider, a breastfeeding supporter, or LLL websites for current information.
• Contact an LLL Leader or your local LLL group for more information and support.

Things to avoid

Some of the treatments that used to be recommended for mastitis don’t help, and may even make things worse:

• Rough massage of your breasts. This can increase inflammation – and really hurts! If you want to massage while feeding or expressing, use gentle touch, as if you were stroking a cat. 

• Applying a lot of heat, e.g. hot showers or compresses. Heat can increase inflammation.  If a little warmth helps the milk to flow when you’re feeding or expressing, or helps you feel more comfortable between feeds, use it for as short a time as possible. Don’t direct a hot shower straight at your breast.
• Electric toothbrushes, combs or other devices. Trying to force milk out of the breast won’t fix the inflammation and may make it worse.
  
• Trying to remove a lot more milk than usual. This can increase the amount of milk you’re producing, increasing pressure in the breast. If you need to express more milk than your baby wants, aim to express just enough to be comfortable – not every available drop.

My breasts feel full but I can’t get milk out – help!

Babies sometimes refuse to feed on a breast that has mastitis. The milk is safe for your baby but may taste different from usual. Your baby may also be objecting to a slower flow of milk – some people notice a temporary supply dip during mastitis. It usually goes back to normal when the breast has recovered. You will need to express milk from the affected breast until your baby is willing to feed on it again.

See Nursing Strikes for ideas to encourage your baby to feed.

What if your baby will feed, or you’re trying to express, but little or no milk is coming out? 

Don’t panic! Engorgement or mastitis can act like a traffic jam in the breast. These tips can help you get the milk moving again:

• Treat the inflammation by taking ibuprofen and perhaps applying a cold compress about 20-30 minutes before you feed or express. 
• If your baby is struggling to attach because the whole breast is engorged (full and tight), try expressing a little milk before offering the breast to your baby. Or try ‘reverse pressure softening’: press firmly around the nipple with fingertips or finger lengths for about one minute before feeding. This moves swelling away from the nipple.
• Try gentle ‘lymphatic drainage’ massage (towards your armpit). See Further Reading.

Do I need medical help?

If you’re feeling okay in yourself (you don’t have a fever or feel ill), you can try treating yourself at home for 24 hours. If by that time your symptoms are improving, you can continue for another 24 hours. 

Contact NHS 111 or your GP straight away if:

• Your symptoms are the same after 24 hours, or getting worse
• You start to feel ill – shivery, shaky, like you have flu
• You have a fever
• A patch on your breast has changed colour and is getting larger, or you see streaks on your breast 
• You see signs of infection, such as a wound that looks crusty or oozes yellow, or your nipple is a different shape, size, or colour from normal.

You may need antibiotics. The NHS guideline on mastitis says that you should usually be given a 10-14 day course (if you have a shorter course, the mastitis is more likely to come back). If you need antibiotics, it’s important to keep up with the self-help treatments above, as well as taking the medication. Let your doctor know if you’re still not feeling any better by the third day after starting antibiotics.

How can I prevent mastitis in the future?

• Get breastfeeding help if you need it. A breastfeeding supporter can help you get your baby deeply and comfortably attached at the breast.
• Keep your milk flowing. Avoid too much milk building up in your breasts: feed or express as much as your baby wants, and offer extra feeds or express some milk if your breasts become uncomfortable at other times. If you have a lot more milk than you need, a breastfeeding supporter can help.
• Check your breast comfort. Make sure nothing is pressing on the breast (see above, “Why does it happen?”)
• Watch out for early signs of mastitis and start self-help measures right away.

Mastitis can be horrible, and make you question whether you can carry on breastfeeding. It’s important not to suddenly stop removing milk while you’ve got mastitis, as this can lead to complications. You need plenty of practical and emotional support, and good medical care if necessary, until you’re feeling better. 

Written by Jayne Joyce and Justice Reilly

Last updated June 2024

Further Reading

A Sudden End to Breastfeeding
Comfortable Breastfeeding
Dummies & Breastfeeding
Engorged Breasts – Avoiding & Treating
Expressing Your Milk
Hand Expression of Breastmilk
How Milk Production Works
My Baby Won’t Breastfeed
Positioning & Attachment
Rhythms & Routines
Sleep Baby – Why and What To Do
Tongue-tie & Breastfeeding
Too Much Milk & Oversupply
When a Mother is Unwell

La Leche League International article on mastitis: https://llli.org/breastfeeding-info/mastitis/ 

References

Mastitis

Baeza, C. et al. 2022. Re: “Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022” by Mitchell et al. Breastfeed Med 2022 17(11):970-971.

Douglas P. Re-thinking benign inflammation of the lactating breast: A mechanobiological model. Women’s Health. 2022;18. doi:10.1177/17455065221075907

Mitchell, K.B. et al.; Academy of Breastfeeding Medicine. 2022. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med 17(5):360- 376. Erratum in: Breastfeed Med 2022 17(11):977-978.

NICE Mastitis and Breast Abscess (Clinical Knowledge Summary)

Last revised in December 2023Wilson, E. et al. 2020. Incidence of and risk factors for lactational mastitis: a systematic review. J Hum Lact 36(4):673-686.

Engorgement

Zakarija-Grkovic I, Stewart F. Treatments for breast engorgement during lactation. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD006946. DOI: 10.1002/14651858.CD006946.pub4.

Blebs

Douglas P. Re-thinking lactation-related nipple pain and damage. Womens Health (Lond). 2022 Jan-Dec;18:17455057221087865.

Mitchell KB, Johnson HM. Breast Pathology That Contributes to Dysfunction of Human Lactation: a Spotlight on Nipple Blebs. J Mammary Gland Biol Neoplasia. 2020;25(2):79-83.

 O’Hara, M. A. Bleb histology reveals inflammatory infiltrate that regresses with topical steroids: A case series. Breastfeeding Medicine. 2012

Over-the-counter medication

NHS Specialist Pharmacy Service – UK Drugs In Lactation Advisory Service

Using paracetamol during breastfeeding, published November 2023

Using NSAIDS during breastfeeding, published February 2024

Other websites

Academy of Breastfeeding Medicine Clinical Protocol #36:The Mastitis Spectrum, 2022. https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf

Books
The Womanly Art Of Breastfeeding. LLLI, London: Pinter & Martin, 2010

Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.

This information is available to buy as a printed booklet from our shop.

Copyright LLLGB 2024