Breastfeeding mastitis: what it is, how to prevent and treat it

Reddened, hard, painful, hot breasts. These are the most well-known symptoms of mastitis – an inflammatory process in the breast, which may or may not be accompanied by infection.

According to Livia Daia, obstetrician gynecologist and mastologist at Daia Venturieri clinic, mastitis has an incidence of 2.6 to 33% in women and varies according to the cause.

The best known is puerperal mastitis (mastitis in/from breastfeeding), caused by the accumulation of milk and its contamination by bacteria that can enter the breast, for example, through cracks in the nipples.

A very common question is: should a woman stop breastfeeding her baby if she has mastitis during this period? Below you can find the clarification for this and other important questions on the subject!

What is breastfeeding mastitis and what are the causes?

Erica Mantelli (CRM-SP 124.315), specialist in Gynecology and Obstetrics, postgraduate in Legal Medicine and Medical Expertise and Sexology/Human Sexuality at the University of São Paulo (USP), explains that, in general, mastitis is caused by an accumulation of milk that is stopped in the breast, which can lead to an inflammatory process and bacterial contamination.

“The main cause is when the milk becomes clogged, it stays still for a long time, when production is excessive and is not meeting demand and, mainly, due to the incorrect attachment of the baby – which can lead to a fissure in the breasts, especially in the breasts. nipples, which is a gateway for bacteria”, highlights Erica.

“A trauma, that is, hitting the breasts after a fall, for example, can lead to a process of mastitis, and also sudden weaning – when the baby stops breastfeeding or the mother for some other reason needs to do this weaning – can cause mastitis”, adds the specialist.

Should I stop breastfeeding if I have mastitis?

This is the main doubt when it comes to mastitis in breastfeeding. And, contrary to what many people think, the answer is: no.

“We do not advise the interruption of breastfeeding due to the great importance of breastfeeding, in addition to the fact that breast emptying is part of the treatment to improve mastitis”, replies mastologist Livia.

Erica emphasizes that women should not stop breastfeeding. “The first step is: if you notice any change in the breast – such as a very large increase, with a change in color or redness, intense pain, pus leakage, bruises or any pain – this has to be reported to the doctor immediately, so so that he can evaluate and prescribe the appropriate medication and provide adequate guidance in relation to breastfeeding”, he explains.

“And lactation consultants can help a lot at this stage too, so it’s important to seek help, but not stop breastfeeding, because if you stop, the process can get worse,” adds Erica.

How to prevent mastitis while breastfeeding

“In the case of puerperal mastitis, we should not leave the breasts full of milk (called breast engorgement) to avoid stasis. And a good grip prevents cracks in the nipples (which is what facilitates the entry of bacterial agents)”, replies Livia.

The gynecologist and obstetrician Erica reinforces that the prevention of mastitis is mainly given by the proper handling of the baby. “The baby has to suckle not only the nipple, he has to take the whole areola, that’s how he manages to latch correctly. You need to make sure the baby’s mouth is open properly and the chin is touching the mother’s chest… So latching and feeding position are very important,” she says.

“Some problems also in the baby’s oral cavity can affect whether the latch is correct, so sometimes it is important to follow up with a speech therapist”, adds Erica.

In addition to the correct latch, Erica points out, if the breast is very full at the time of giving the breast to the baby, it is important to do a light milking: make a drip of that first milk to later put it in the baby’s mouth. “With this, the breast becomes softer and the milk will come out more easily. When the breast is very urged, very full, the baby tries to suckle, but with a very hard breast, the milk takes longer to come out. Thus, the baby is often irritated, begins to suck more and more and, in an incorrect grip, can lead to injury. Leading to the wound, it is a gateway for possible bacteria,” she explains.

It is also important, according to Erica: for the mother to wash her hands well before breastfeeding and avoid using shells (because milk can accumulate there and this is a culture medium that can also lead to mastitis).

It is also worth mentioning that the mother with mastitis should continue breastfeeding so that the baby can empty the breast and the condition can then improve.

How to treat mastitis while breastfeeding?

How is the treatment done? Are there ways to ease the pain from mastitis?

Livia responds that, in general, the treatment includes: calming the mother and family members; promote manual breast emptying or through breastfeeding the infant (always with guidance); the use of cold compresses, analgesics and anti-inflammatories, which will help to alleviate the pain, in addition to antibiotics when necessary. “In some more complicated cases, there is a need for surgical treatment”, says the mastologist.

The gynecologist and obstetrician Erica reinforces that the first step is the medical evaluation. “The treatment depends on this assessment. Antibiotics are often prescribed and, in more severe cases, surgical procedures are required to drain the pus accumulated inside the breasts. It is also possible, for injuries, topical treatment and the use of laser. All this will also help to restore the skin and relieve pain, thus providing greater comfort for feedings”, she explains.

It is important to know that mastitis is a case located in the breasts, however, when not treated correctly, the delay in diagnosis and initiating medication can worsen the condition, causing this infection – instead of just being in the breasts – to spread. . “This can lead to asepsis, which is a generalized infection, and to very serious cases, in which it is often necessary to stay in the ICU for the antibiotic, and this can put the woman’s life at risk”, explains Erica.

“So, mastitis is an infection initially in the breasts, which has treatment and has a quick resolution, but which, if not treated, can harm the mother and lead to a much more serious condition”, concludes Erica Mantelli.

To avoid mastitis during breastfeeding, it is important to emphasize that the breasts are properly emptied by sucking the breast and, when this is not possible or sufficient, by expressing excess milk. It is also necessary to avoid cracks in the nipples, paying attention to the correct latch of the baby at the time of feeding. In the event of any change in the breast and/or difficulty in promoting correct attachment, it is essential to seek professional advice as soon as possible.