Mastitis and Engorged Breasts

What is Mastitis?

  • Defined as “inflammation of the breast”. The term is generally used in reference to the lactating breast.

  • Is thought to occur when pressure within the ducts is greater than the surrounding tissue. This causes milk products to leak into surrounding tissue and the body produces a dramatic inflammatory response.

  • This in turn can cause painful, red, hot and inflamed breast tissue.

  • Incidence of mastitis has been reported to be as high as 1 in 3 women postnatal, with the highest incidence occurring 2-3 weeks postnatal. Mastitis is the most common reason to wean in the first 12 weeks postnatal.

Symptoms may include:

  • Breast tissue feeling tender

  • Increased temperature of the breast tissue

  • Redness in a wedge-shaped or striped pattern on the breast tissue

  • Chills, ache and flu-like symptoms, similar to a systemic illness

  • The inflammation may or may not involve a bacterial infection (the only way to rule out a true infection is by doing a milk sample testing – but this step is often skipped as it takes a long time)

Risk factors and things to avoid:

  • A previous episode of mastitis

  • A sudden change in number of feeds (ie. infant sleeping longer overnight, skipped feeds)

  • Switching to 2nd breast before 1st breast is finished

  • Suckling replaced by pacifiers or bottles

  • Compression- including flange of expressing pump, tight bra/garment

  • Positioning and attachment problems (eg. from tongue tie, nipple damage)

  • Pendulous large breast tissue

  • A direct blow to the breast

 How physiotherapy can help:

  • Diagnosis and advice- including appropriate referral

  • Therapeutic Ultrasound can be very effective in the management and treatment of mastitis. This will likely form part of your treatment and will be explained by your physiotherapist.

  • Education regarding manual handling of your breast: This must always be gentle; respect your pain.

  • Self-management techniques including massage and breast rotating/breast lifting techniques. 

  • Positioning and feeding advice

Special extra tips:

  •  If possible try to bring you baby with you as it is helpful to have your baby feed immediately after the session.

  • Develop the habit of feeling each breast after each feed to highlight any areas of tension.

  • Always maintain adequate hand hygiene and breast pad hygiene.

  • If it is safe to do so, Non-Steroidal Anti-Inflammatory medications (NSAIDs) may be recommended.

  • It is almost always ok for your baby to continue feeding if comfortable.

  • Avoid over-stimulating the breast tissue

  • Ensure the duration between feeds is short enough so breasts do not feel uncomfortably full.

  • Expressing must be comfortable and/ or relieving.

  • Take care that the flange does not compress the breast

  • Avoid wearing tight compressive garments, ie, tight bra/flange of expressing pump. Garments should not indent skin.

  • Catch it early: look out for early signs to prevent the condition from becoming debilitating or a more serious health problem that might threaten yours and the baby’s well-being.