Symptoms
- Hard swelling in the breast, with redness of the overlying skin and severe pain.
- Usually, only a part of one breast is affected.
- Fever and feeling ill.
- Mastitis is commonest in the first 2–3 weeks after delivery but can occur at any time.
Causes
- Long gaps between feeds, for example when the mother is busy or resumes employment outside the home, or when the baby starts sleeping through the night.
- Poor attachment, with incomplete removal of milk; unrelieved engorgement; frequent pressure on one part of the breast from fingers or tight clothing; and trauma.
- Milk staying in the breast, or milk stasis, which results in non-infective inflammation.
- Infection may supervene if the stasis persists, or if the woman also has a nipple fissure that becomes infected, leading to infective mastitis.
Management
- Improve the removal of milk and try to correct any specific cause that is identified.
- Advise the mother to rest, to breastfeed the baby frequently, and to avoid leaving long gaps between feeds.
- Do not stop breastfeeding.
- Analgesics (if available, ibuprofen, which also reduces the inflammation of the breast; or paracetamol).
- If symptoms are severe, if there is an infected nipple fissure, or if no improvement is seen after 24 hours of improved milk removal, the treatment should then include penicillinase-resistant antibiotics (e.g., flucloxacillin).
- Antibiotics will not be effective without improved removal of milk.