Managing Mastitis Like A Boss 

The American Academy of Breastfeeding Medicine recently updated its protocol on mastitis and it is a game changer for the treatment, as well as the understanding of mastitis as a whole. Read on to have a better understanding of mastitis and clogs, home care options, things to avoid, and lines of antibiotic treatment to discuss with your medical provider, as well as information on your all-important breast microbiome.

What is mastitis? 

Mastitis is the disruption of the healthy milk microbiome that can cause inflammation in the milk ducts as well as edema, or fluid retention in your breast. It can range from subacute mastitis which may not require antibiotics to acute bacterial mastitis which will require antibiotic treatment. We no longer think of mastitis as a single condition, but now view it as a spectrum of conditions.

The following is the Academy of Breastfeeding Medicine’s definition of mastitis: “Mastitis encompasses a spectrum of conditions resulting from ductal inflammation and stromal edema.” Essentially mastitis is inflammation of the mammary gland.  During mastitis the ducts which transport the milk become inflamed and narrowed.  Narrowing of the ducts can occur from edema in the breast tissue, oversupply, or dysbiosis (an imbalance of good/harmful bacteria in the breast). 

According to the Academy of Breastfeeding Medicine, “Basic science research has demonstrated that multiple factors contribute to the development of mastitis.  These include host factors such as hyperlactation, microbial factors such as diversity of the milk microbiome, and medical factors such as antibiotic and probiotic use.” 

• Hyperlactation = producing more milk than needed aka oversupply 
• Breast microbiome = the balance of bacteria in the breast 

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How common is mastitis?

There is a false belief that mastitis is a rare phenomenon, but in truth, it affects 1 out of 3 mothers. Let’s unpack this big topic together to help you have a better understanding of what you can do now to help prevent the occurrence of mastitis and clogs, plus what to do if you are already dealing with mastitis. 

Are clogs and mastitis two different things?

Part of the problem for providers is we used to think clogs and mastitis were two separate phenomena. The current science is pointing to them being part of the mastitis continuum. 

A nursing parent can have varying degrees of inflammation and edema that can lead to a range from clogs to inflammatory mastitis to bacterial mastitis and abscesses. 

Risk factors for developing mastitis and clogs

There are a lot of factors at play that come from three main branches that impact the breast microbiome and can make a person more or less likely to develop mastitis. 

1. The first is the genetic background and breastfeeding-related causes such as pumping and oversupply. 
2. The second is related to microbial factors in and on the breast. 
3. The third is related to medical factors, such as; the use of antibiotics, probiotics, and iron supplementation. 

Home care for mastitis and clogs

So you find yourself on the mastitis spectrum, what now? To start, we want to address changes you can make on your own. 

• Feed your baby on demand: We want to feed your baby on demand, but not focus on "emptying the breasts." Try to stick to your regular feeding and/or pumping schedule. 
• Correctly fitting bra: Be sure you are wearing a correctly fitting and supportive bra. Overly tight sports bras, underwire bras, or any other type of bra that is digging into your breast tissue, can contribute to the development of clogs. 
• Ice is your friend: Icing up to 15 minutes at a time can help reduce inflammation.
• Ibuprofen + Tylenol: Using and alternating, ibuprofen and Tylenol can also help decrease inflammation and pain. 
• Light lymphatic massage: use the palm of your hand to LIGHTLY sweep up from the center of your breast up toward your armpit where most of the lymphatic drainage for your breast occurs.   This helps direct inflammatory fluids up into the lymphatic system to be processed in the body. 

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**It is important to note, that while all of these are home remedies, it is vital to be in communication with your healthcare provider should antibiotics be necessary to resolve your symptoms.**

Things to avoid

• Avoid aggressive massage of the breast tissue. This is a big one and one that is slow to die out. Massage can cause MORE inflammation, which is the exact opposite of what we are going for with self-treatment.
• Pumping in excess of your regular pumping schedule or pumping after feeding your baby, if it is not something you already regularly do. This is a tricky one, because you may have been told or think it would be a good idea to keep the breasts as empty as possible. 

• Unfortunately, emptying in excess of your regular routine can create more of a problem by paving the way to an oversupply. This may lead to a cycle of inflammation and recurrent symptoms. 

• Using heat excessively. While rotating ice and heat may be helpful, overuse of a heating pad can cause more inflammation. Some mothers will find using heat just during feeding to be helpful with milk flow but ice between feedings. 

When do I call my doctor about mastitis?

Sometimes mastitis will clear on its own with supportive measures like breast rest, ice, and anti-inflammatories. If you have a fever and generally feel like crap for over 24 hours with no improvement it's time to call your provider. 

What kind of treatment do I need for bacterial mastitis?

The course of antibiotic treatment should be 10-14 days, any less may not fully clear the infection. 

FIRST LINE OF TREATMENT

💊Dicloxacillin or flucloxacillin 500 mg QID for 10–14 days

💊Cephalexin 500 mg QID for 10–14 days

SECOND LINE OF TREATMENT

💊 Clindamycin 300 mg four times daily for 10–14 days

💊 Trimethoprim-sulfamethoxazole DS BID for 10–14 days (not for mothers of infants less than 30 days old)

If your provider doesn’t seem informed on treating mastitis

Some doctors simply aren’t up-to-date with the newest information on the treatment of mastitis.  If you don’t feel like you are getting the correct treatment refer your doctor to the latest recommendation for the treatment of bacterial mastitis from the Academy of Breastfeeding Medicine ABM clinical protocol #36. 

Feel free to quote this to your OB or other medical providers when seeking treatment you can even print it out and bring it with you to the appointment. The more you know, the better off your treatment may be. This is especially helpful if you are being seen for treatment in an ER or urgent care center. 

What is the breast microbiome?

Your microbiome is made up of all the bacteria that take up residence in and on your body. Sounds gross, but these little fellas and gals put in the work for you. For a long while, it was believed that breastmilk was sterile, we now know not only is breastmilk not sterile, it contains multitudes including Staphylococci, Streptococci, Corynebacteria, lactic acid bacteria, Propionibacteria, and Bifidobacteria, to name an important few. 

Your breasts and breast tissue also have their own bacteria that make up the breast microbiome and contribute to the health of breast tissue and can both increase or decrease the occurrence of mastitis and clogs. 

How does your breast microbiome impact mastitis and clogs?

Having a healthy and diverse breast microbiome can be a protective factor and decrease your odds of mastitis and clogs! The opposite can also be true, unfortunately, a breast microbiome that is not diverse can contribute to the occurrence and recurrence of mastitis and clogs. 

Your breast and gut microbiome have far-reaching consequences for everything from inflammation to your immune responses and your metabolism. It is no surprise that your microbiome would have a huge impact on your breastfeeding journey. 

What can you do to improve your breast microbiome?

While we still are in the early stages of understanding the vast role of the breast microbiome, scientists have isolated various strains of Lactobacilli from human milk (such as Lactobacillus fermentum and Lactobacillus salivarius), and the presence of these organisms is thought to be protective against breast infections, or mastitis. 

So now you know about the good bacteria's work in and on your body...here are daily practices and supplements that can help diversify your microbiome.

• Eat the rainbow, no for real. What does that look like? A diverse diet filled with a variety of fruits, vegetables, seeds, nuts, and protein sources. This can help feed the beneficial bacteria in and on your body. 
• Say no to a breast scrub-down. You read that right. Your boobs do not need a daily disinfectant experience. When we use harsh soaps and water daily, we disrupt and possibly harm our microbiome.
• Consider a probiotic like, Klaire labs Target B2 or Lactation Hub’s Breast Health supplement (I love this one cause it also includes choline) to help support your microbiome if dealing with clogs, or mastitis.

Should I take sunflower lecithin to treat clogs?

Sunflower lecithin is an emulsifier that contains choline. It is believed that choline is the active part of sunflower lecithin that is beneficial to breast health.  I recommend using choline as opposed to sunflower lecithin to support breast health because in some parents sunflower lecithin can cause GI upset and disrupt the lining of the gut. Women who are breastfeeding are recommended to consume 550 mg of choline daily throughout the first year postpartum, for more information on choline and why it is important check out this article. 

Should you massage out breast clogs?

I know you probably have seen this on TikTok, but I promise you aggressive breast massage will only make inflammation of the breast WORSE! According to the Academy of Breastfeeding Medicine, “Deep massage causes increased inflammation, tissue edema, and microvascular injury,” JUST DO NOT DO IT!

What should you do for a clog?

• ICE to reduce inflammation 
• Light lymphatic massage to reduce inflammation
• Ibuprofen or Tylenol to reduce inflammation
• Address microbiome 
• Address oversupply (if you know you have an oversupply working one-on-one with an experienced IBCLC will be key to getting you out of the mastitis/clog cycle.) \

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Are you ready for even more info on mastitis, clogs, and breast pain? My best-selling live workshop, Boob Hell is live in Boob School. After watching Boob Hell, you will walk away knowing how to advocate for yourself, how to treat yourself without making symptoms worse, and a game plan for prevention! 

I hope this was helpful along your journey. While we are just at the beginning of understanding the breast microbiome, it is exciting to learn that there are active steps to take to help you prevent and combat recurrent mastitis and clogs. 

Ready for more help, today? Check out Boob School, to get more knowledge, support, and empowerment for your breastfeeding journey! Here’s what you get….14+ modules to take you from your very first latch to weaning your baby. 11 bonus PDFs so you never have to do a 2 am Google spiral. A free membership to Natural Breastfeeding where you can watch 60+ videos of other moms latching their babies. Get access to our private Facebook group and weekly support group calls. Get the support you deserve, today!

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Cheering you on, always!!

XOXO

Kelly

Boob School Founder and CEO

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