MASTITIS UPDATE: Flipping What We Once Thought About Mastitis On Its Head

In 2022, the Academy of Breastfeeding Medicine (ABM) completed extensive research leading to new findings about mastitis. Their recent discoveries really do flip what we once thought about mastitis on its head. We may even have been treating parts of it wrong (although this was based on the evidence at the time). So with the help of my wonderful aunty, Susan Shaw, who is a fantastic Melbourne-based lactation consultant and guidance from the new protocols, I present to you PMPP’s updated blog post for mums regarding mastitis. 

What is Mastitis?

In the past we attributed mastitis to an infection in the breast from a “clogged duct” or “milk plug”. We now know that mastitis is encompassed by a spectrum of conditions and is primarily put down to inflammation and swelling (breast engorgement). This is more often than not brought about by hyperlactation (oversupply) and dysbiosis (an uneven balance of harmful and healthy breast bacteria). Below is an image of the mastitis process. To get an accurate diagnosis of where your mastitis episode fits on the spectrum, either organise a consultation with a Lactation Consultant (LC) or book in with one of the Physiotherapists at PMPP for assessment and treatment.

Where do I find a lactation consulant?

The Physiotherapists at PMPP have a list of local lactation consultants that they can refer you to, or you can search for a nearby accredited Lactation Consultant by clicking on the link below:

https://www.lcanz.org/find-a-lactation-consultant/

Your Lactation Consultant or Physiotherapist can also pick up whether your breast pain and tenderness is not in fact mastitis and is instead attributed to another cause (i.e. cellulitis, thrush, cyst, engorgement).

Mastitis Made Simple:

Credit for this analogy goes to Katrina Mitchell (MD/IBCLC). To put it simply, mastitis is like a traffic jam. There is still flow albeit with congestion; which similarly happens in mastitis due to the inflammation throughout the breast tissue. In this instance, to ease the traffic jam you have two solutions:

1. Reduce the water to allow the road to widen (i.e. decrease the inflammatory fluids) or;
2. Decrease the size of the cars (i.e. emulsify the milk by using a lecithin supplement).

Risk factors for Mastitis – Hyperlactation and oversupply:

Risk factors are predominantly due to an increased risk of hyperlactation/oversupply and dysbiosis. These include:

• • Incorrect weaning from breastfeeding.
  • Compromised immune system (fatigue, stress etc).
  • Pumping to “keep the breast empty”.
  • Firm massage / “breast gymnastics”.
  • Overuse of Haaka devices to “release a plug”.
  • Overuse of epsom salt soaks and castor oils – these can macerate nipple tissue and encourage dysbiosis and/or infection.
  • Heating the breast.
  • Perinatal mood and anxiety disorders.

Preventing Mastitis:

• Regular feeds, nurse on demand.
• Try to drain the first breast before offering the second breast (if baby wants/needs the other side).
• Feed equally on both sides (even if one breast produces more milk than the other).
• No firm massage. Instead use soft, sweeping massage as if you are “petting a cat”.
• Prenatal education about the early signs and symptoms of mastitis from your Lactation Consultant, Women’s Health Physiotherapist or Maternal & Child Health Nurse.
• Ensure a proper fitting bra (supportive but not so tight that it leaves visible marking on the skin). We recommend the bra fitting services at these places: 

Brava Lingerie: https://www.bravalingerie.com.au/?gclid=CjwKCAiAjPyfBhBMEiwAB2CCInUhXfE4fz0KLJqqKnAb8NJieTCVEksE55dl3220h1ow_V9idzDRRRoC_ScQAvD_BwE

She Science (good sports bras): https://shescience.com.au

Dickory Dock: https://www.google.com/search?client=safari&rls=en&q=dickory+dock&ie=UTF-8&oe=UTF-8

What To Do If You Suspect That You Have Mastitis – Treatment:

• Book in to see a Lactation Consultant to treat the root of the issue (hyperlactation and oversupply), especially if weaning or getting recurrent bouts of mastitis.
• Physiotherapy for therapeutic ultrasound.
• Wait 24 hours to see whether the conservative inflammatory measures work before seeing a doctor for antibiotics. They may not be warranted and can contribute to further dysbiosis if prescribed too early in the spectrum.
• Speak to your healthcare provider to determine whether antibiotics are right for you.
• Massage: gentle lymphatic massage NO deep/firm massage or vibration.
• Gentle breast compression during milk expression is still recommended. If you’re unsure about how to do this, speak to your Lactation Consultant.
• NO epsom salts or similar products.
• NO heat.
• NO extra pumping/milk removal – promotes overstimulation and hence hyperlactation.
• Avoid breast shields – nipple shields don’t allow for the exchange of healthy bacteria between Mum and baby, which can be a risk factor for dysbiosis. 
• ICE & anti-inflammatories (speak to your Lactation Consultant or pharmacist). Wrapped ice packs, frozen peas or wet a disposable nappy and freeze it. We love BodyICE women’s ice packs (stocked at PMPP).
• Breast rest & bed rest!!!!!!!! 
• Mastitis is often a tell tale that you’re overexerting yourself. 
• Stay hydrated, drink plenty of fluids.
• Invest in a correctly fitted bra & wear loose clothing.
• Lecithin supplements – emulsifies milk and reduces inflammation. The ABM recommends 5-10 grams a day.
• Cabbage over breast – cools the breast.

Lymphatic Massage:

• Massage towards the lymph nodes (in the armpit and towards the breastbone) NOT towards the nipples.
• Using the pads of your fingers make soft, gentle sweeping motions in the below directions.
• From the nipple towards the armpit.
• From the nipple towards the breastbone.

If you think that you’re suffering from mastitis or have any questions or concerns during your pre- or post-natal journey, come and see the wonderful team at PMPP . We have treated many, many women with mastitis and can guide you through it all. We also know when to refer you on to other specialists if need be.

~Emily Tregear
Physiotherapist

You may enjoy these other related PMPP blogs:

https://portmelbournephysio.com.au/exercising-during-pregnancy/
https://portmelbournephysio.com.au/pregnancy-hormones/
https://portmelbournephysio.com.au/why-a-post-natal-physio-check-up-is-essential/