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  • Writer's pictureLeticia Lugo

Rethinking Mastitis: New Views and Treatments




As doulas and educators, it's imperative that we remain informed about evolving research, enabling us to impart evidence-based, precise knowledge to our valued clients. One of the newest updates in the area of lactation addresses mastitis and “blocked” milk ducts.


The Academy of Breastfeeding Medicine (ABM) updated its guidelines on mastitis in May 2022 to reflect the latest research, which suggests that mastitis is a spectrum of conditions that can range from mild inflammation to severe infection. The traditional view of mastitis is that a bacterial infection of the breast milk ducts causes it. However, the Academy of Breastfeeding Medicine now believes this is not always the case. In fact, many cases of mastitis are not caused by bacteria at all. Instead, they are caused by other factors, such as:


  • Hyperlactation (too much milk production)

  • Mammary dysbiosis (an imbalance of bacteria in the breast milk)

  • Clogged milk ducts

  • Nipple trauma

  • Stress


The ABM has classified mastitis into three categories:


  • Inflammatory mastitis: This is the mildest form of mastitis and is not caused by an infection. It is characterized by redness, swelling, and pain in the breast.


  • Bacterial mastitis: This is a more severe form of mastitis that is caused by an infection. It is characterized by the same symptoms as inflammatory mastitis, but it may also be accompanied by fever, chills, and fatigue.


  • Abscess: This is the most severe form of mastitis. It is characterized by a collection of pus in the breast.


The treatment for mastitis depends on the severity of the condition. Inflammatory mastitis can usually be treated with conservative measures, such as rest, increased fluids, and pain medication. Bacterial mastitis may require antibiotics. Abscess may require surgery to drain the pus.


The Academy of Breastfeeding Medicine recommends that women who are breastfeeding and experience symptoms of mastitis seek medical attention as soon as possible. Early diagnosis and treatment can help to prevent the condition from progressing to a more severe form.


It's also now recommended that the term "infective mastitis" be used to refer to cases of mastitis that are caused by bacteria. This helps to distinguish between cases of mastitis that are caused by infection and cases that are not.


The treatment for mastitis will vary depending on the underlying cause. In cases of infective mastitis, antibiotics are usually prescribed. However, in cases of non-infective mastitis, antibiotics are not usually necessary. Instead, the focus is on treating the underlying cause by reducing milk production, improving milk drainage, or addressing any underlying medical conditions.


Here are some tips to help prevent mastitis:


  • Nurse your baby frequently and on demand.

  • Avoid pumping for long periods of time.

  • Gently express milk after nursing to make sure all of the milk is drained.

  • Keep your nipples clean and dry.

  • If you have a cracked or sore nipple, apply a warm compress and let it air dry.

  • Get enough rest and drink plenty of fluids.

  • Manage stress.

  • If you do develop mastitis, it is important to continue breastfeeding. Breastfeeding can help to drain the infected milk ducts and promote healing. You may also need to take antibiotics. With proper treatment, most cases of mastitis resolve within a few days.


We need to rethink the term “clogged milk ducts” and instead view it as “narrowed” or “inflamed” milk ducts. Where does this inflammation come from? It is usually brought on by dysbiosis (imbalance of the breast microbiome), and may also be caused by hyperlactation, which left untreated can lead to inflammatory mastitis.


Ductal inflammation should be treated similarly to how we would treat other forms of inflammation throughout the body. For example, if you were to have a sprained ankle, would you apply heat and vigorously massage it? No, of course not. You would likely rest it, apply ice, and take an anti-inflammatory. We should think of the breasts in the same way. The new protocol should be to NOT over-feed on the affected side but instead only express for comfort. Use anti-inflammatories such as ibuprofen. Use acetaminophen for pain relief. Possibly use sunflower or soy lecithin to reduce inflammation and emulsify the milk (discuss with care provider and IBCLC).


Will milk production be impacted? Usually, yes. With less removal of milk on the inflamed side, the breasts may downregulate in production to allow for the inflammation to subside. Once inflammation is subsided, resuming typical feedings and/or pumping sessions will trigger the body to upregulate again and milk production should increase.


An easy way to remember the new protocol is by using the acronym B-A-I-L:


Breast Rest

Anti-inflammatory (ibuprofen)

Ice

Lymphatic drainage


If you are experiencing symptoms of mastitis, it is important to see a doctor to get a diagnosis and the appropriate treatment. Early diagnosis and treatment can help to prevent mastitis from becoming more severe.




References:

Darla Burns (2023) Changing the Way We View and Treat Mastitis. Cappa Website.

Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022


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