Signs and symptoms: 
Symptoms can develop quite suddenly and may include: 
 
- A painful, tender area of the breast 
- Swelling or firmness 
- Redness, although this can look different depending on skin tone 
- Warmth over the affected area 
- Fever or chills 
- Body aches or flu-like symptoms 
- Feeling generally unwell 
 
If your symptoms are severe or continue to worsen, it's important to seek medical assessment. 

What should you do if you think you have mastitis? 
One of the biggest changes in recent years is how we manage mastitis. The old advice was often to massage the lump firmly, apply heat, and try to empty the breast as much as possible. We now know that this can actually increase inflammation. Instead, think of mastitis like a sprained ankle. The aim is to reduce inflammation while continuing to remove milk normally. Most cases of mastitis are inflammatory, not bacterial and therefore often don't require antibiotics for treatment despite them still being prescribed regularly. It's important to note, a temperature does not always mean an infection and sometimes is just your body's response to the increase in inflammation within the body and with time and management of the inflammation this will improve.   

Continue feeding your baby: 
Breastfeeding is safe to continue, even if you have mastitis. Feed on demand or continue your usual pumping schedule if you're expressing. Ensure you are getting a good latch each time or using the right flange and pump settings if pumping. There's no need to try and "empty the breast completely" or pump excessively, as this can increase milk production and worsen inflammation. 

Use ice: 
Cold packs applied for 10–20 minutes at a time between feeds can help reduce swelling and relieve discomfort. Many parents find this far more effective than heat.

Rest: 
Your body is working hard to recover. Rest whenever you can, accept help from those around you, and keep up your fluids and regular meals. 

Consider anti-inflammatory medication: 
If it's safe for you, anti-inflammatory medications such as ibuprofen can help reduce both pain and inflammation. Paracetamol can also help with pain and fever. Always follow the advice of your healthcare provider and the medication packaging. 

Avoid deep massage: 
Firm massage or trying to "break up" a lump can cause further damage to the breast tissue and increase inflammation. There is no need to try and massage a lump firmly towards the nipple, or to use any other forms of vibration or suction. This will only make your symptoms worse. 

Lymphatic drainage massage: 
Lymphatic drainage massage is gentle massage techniques used to flush inflammation back into the lymphatic system. To do this, massage techniques should be focused on stroking towards the armpit where the lymph nodes are located and be very gentle to avoid further damage  
 
Therapeutic ultrasound:  
Therapeutic ultrasound may be recommended by an IBCLC or women's health physiotherapist trained in its use. Unlike the ultrasound used during pregnancy to create images of your baby, therapeutic ultrasound uses sound waves to help reduce inflammation within the breast tissue and promote healing. 

When are antibiotics needed? 
Because not all mastitis is bacterial, antibiotics aren't always the first step. However, if you have persistent fever, worsening symptoms, significant redness, or you're not improving after 24-48 hours of conservative management, it's important to see your GP promptly. They can assess whether antibiotics are appropriate. If symptoms continue despite treatment or a painful lump isn't resolving, further assessment may be needed to rule out a breast abscess. 

Preventing mastitis: 

While mastitis can't always be prevented, there are several things you can do to reduce your risk: 

Feed responsively: 
Feed your baby when they show feeding cues and avoid long gaps between milk removal where possible. If you're pumping, try to maintain a consistent routine that matches your baby's needs. Ensure you are using the correct flange size and appropriate pumping settings.  

Optimise your baby's latch: 
A deep, comfortable latch helps your baby remove milk efficiently and reduces the risk of nipple damage. If feeding is painful, it's worth seeking support early. 

Avoid unnecessary pumping: 
Pumping significantly more milk than your baby needs can contribute to oversupply, increasing your risk of recurrent inflammation. Unless advised otherwise, aim to remove milk to meet your baby's needs rather than trying to build a large freezer stash. 

Reduce pressure on your breasts: 
Avoid tight bras, restrictive clothing, or anything that places prolonged pressure on your breasts. Even sleeping positions or baby carriers can sometimes contribute. 

Look after your nipples: 
Persistent nipple pain, cracks, or damage aren't something you should have to push through. Addressing the underlying cause early can reduce your risk of mastitis. 

Look after yourself: 
Although mastitis isn't caused by stress alone, exhaustion, illness, and not eating or drinking enough can make recovery more difficult. It's important to ensure you are caring for yourself too and accepting help where available. 

When to see an IBCLC? 

Any case of mastitis where you are unsure what caused it should be investigated to prevent ongoing issues particularly if you are experiencing recurrent cases. As an IBCLC, we will assess the whole picture, not just the sore breast. Together they will look at your baby's latch, milk transfer, milk supply, pumping routine, nipple health, feeding patterns, and any factors that may be contributing. Sometimes a few simple changes are all that's needed to help prevent it from happening again. 

Mastitis can feel overwhelming, but early support makes a big difference. If you're experiencing breast pain, redness, swelling, or flu-like symptoms, don't ignore them. The sooner inflammation is managed, the less likely it is to progress.