If you are dealing with the pain and discomfort of mastitis, you are likely wondering what to do next. The direct answer is: Yes, you must continue to remove milk from the affected breast, but the approach has shifted from aggressive draining to gentle relief.
For decades, the advice was to "aggressively drain" the breast. Today, we understand that excessive or painful pumping can worsen inflammation, which is the root cause of mastitis. The current recommendation emphasizes gentle and frequent milk removal—whether by nursing, hand expressing, or pumping—solely for comfort and relief, not complete, painful drainage.
Mastitis is a condition where breast tissue becomes inflamed, often due to a blockage (milk stasis) that allows bacteria to multiply, leading to an infection. It is essentially a localized immune response that requires rest, pain management, and gentle milk flow to resolve.
What is mastitis?
Mastitis is an inflammation of the breast tissue that sometimes involves a bacterial infection. It is most common in breastfeeding people but can occur at any time.
The signs and symptoms often come on quickly and may include:
- Pain and tenderness in the breast.
- Swelling or a palpable hard, painful lump.
- Redness of the skin, often appearing wedge-shaped.
- The breast feels warm or hot to the touch.
- Flu-like symptoms, including body aches, fatigue, chills, and a fever of 101°F (38.3°C) or higher.
The common causes of mastitis usually stem from milk stasis, meaning milk is not effectively or frequently removed. This can be due to:
- A clogged milk duct that is not cleared.
- Missed or skipped feedings/pumping sessions.
- Poor latch or positioning during feeding, preventing the baby from fully draining the breast.
- Pressure on the breast from tight-fitting bras or restrictive clothing.
Difference between clogged duct and mastitis
It’s crucial to know the difference between a simple clogged duct and mastitis, as the latter requires close monitoring and often medical intervention:
| Condition | Primary Symptoms | Systemic Symptoms |
|---|---|---|
| Clogged Duct | Localized lump, tenderness, and soreness in one spot. | Generally, you feel fine. No fever or body aches. |
| Mastitis | The entire breast or localized lump is tender, swollen, painful, and red. | You have flu-like symptoms (fever, chills, aches, fatigue) that come on suddenly. |
Should you pump, breastfeed, or hand express with mastitis?
💡 Yes, you must continue to remove milk. Stopping milk removal will likely worsen the engorgement and inflammation.
The clarification: The most important action is effective and gentle milk removal. Experts generally recommend nursing first, as the baby’s suction is often the most effective way to clear the breast.
- Breastfeed: Nurse frequently (every two hours or more) on the affected side first. Start nursing by positioning your baby's chin toward the sore or red area to help focus suction on that specific duct.
- Pump or hand express: If nursing is too painful, or if your baby is unable to transfer milk effectively, use a pump or hand expression. Hand expression is excellent for targeted relief and for softening the areola before a pump session.
Crucially, pumping should not hurt. Aggressive pumping with high suction is counterproductive. If you are experiencing pain, reduce the suction setting or stop. Painful suction can further damage the inflamed tissue and inhibit letdown.
Pumping with mastitis: safe strategies
If you choose to pump, follow these instructional steps to ensure your comfort and prevent further damage:
Pump settings: comfort is key
- Use low suction: Never pump at a suction level that causes pain. You should turn the suction to the highest setting that remains comfortable for you.
- Expression mode vs stimulation mode: Use the stimulation mode (fast cycles, low suction) to initiate letdown. Once milk begins flowing, switch to the expression mode (slower, deeper cycles). Do not increase the suction to painful levels in the expression phase.
Frequency vs. full drainage
- Pump for relief: Pump only long enough to soften the breast, relieve the painful pressure, and ensure adequate milk flow. This may mean pumping for shorter durations (e.g., 10 minutes instead of 20) or less frequently than usual.
- Avoid oversupply: Pumping the breast completely dry multiple times a day can signal your body to make more milk, which may worsen stasis and inflammation. The goal is to maintain flow and comfort, not to completely drain the breast. This is why you need to pump for shorter durations as often as needed to soften the breast.
Choosing the right flange size
Using an incorrect flange size is a common cause of nipple pain and tissue damage, which can lead to or worsen mastitis.
- Correct fit: When the flange fits correctly, your nipple should move freely in the tunnel without pulling too much of the surrounding areola in.
- Too small: If the flange is too small, your nipple and areola may rub against the sides, causing friction and trauma.
- Too large: If the flange is too large, too much of your areola will be pulled into the tunnel, causing pain and ineffective milk removal.
Consult a flange size guide to measure your nipple diameter (base of the nipple, before swelling) and ensure you are using the correct breast shield size, or consult a lactation consultant if you are not too sure. Consider using a hospital grade quality breast pump such as the Perifit Pump for more effective and gentle cycling.
Pain and inflammation management
Rest and pain management are critical for healing:
- Cold therapy: Apply ice packs or cold packs to the inflamed area after milk removal (nursing or pumping) to reduce swelling and pain.
- Gentle massage: Use very gentle massage (like circular fingertip tapping) on the affected area during milk removal. Avoid deep, aggressive massage or pushing hard on the clog, as this can increase inflammation.
- OTC pain relief: Take non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen, which are safe for breastfeeding and help reduce both pain and inflammation.
Preventing mastitis in the future
The best way to manage mastitis is to prevent it from happening again.
- Feeding on demand: Follow your baby’s hunger cues. Do not let breasts become overly engorged. Establish a consistent pumping schedule if you are separated from your baby, making sure to pump when you would normally feed.
- Ensure correct latch: A deep, comfortable latch is essential for effective milk removal. Consult a lactation consultant if you suspect latch issues.
- Avoid tight clothing: Refrain from wearing restrictive bras, especially those with underwire, which can put pressure on milk ducts.
- Wean slowly: If you are weaning, do so gradually to allow your milk supply to decrease naturally, preventing painful engorgement.
- Manage oversupply: If you produce more milk than your baby needs, be careful about over-pumping, as this can be a risk factor for clogs and mastitis.
When to see a doctor with mastitis?
Mastitis can often be managed with rest, pain relief, and gentle milk removal. However, you should contact a healthcare provider immediately if you experience any of the following:
- Symptoms worsen after 24 hours of home treatment.
- No improvement after 48 hours of home treatment.
- You have a high fever (101°F/38.3°C or higher).
- You see red streaks on the breast.
- You feel suddenly and severely ill.
If mastitis is due to a bacterial infection, you will need a course of antibiotics. Your doctor will prescribe an antibiotic that is safe for breastfeeding so you can continue to nourish your baby while you heal.
If you have mastitis, continue to remove milk, but prioritize gentle removal for comfort over aggressive draining. By focusing on rest, gentle milk flow (via nursing or pumping), pain management (especially cold therapy and NSAIDs), and seeking prompt medical care when needed, you can overcome this challenge and continue your breastfeeding journey.
