Mastitis, Slowed Milk Flow, and Milk Blisters

Having a sore breast can be a painful and alarming experience and can occur when there is inflamed tissue in your breast. Your breast may feel tender and there may or may not be redness or a hard spot or sore lump in your breast. Treat any engorgement promptly to avoid developing inflammation of the surrounding breast tissue, which can cause narrowing of the ducts and slowed milk flow or mastitis.

Whether you have a sore breast, a slowed milk flow, or a breast infection, they may all be related to inflammation in the breast causing narrowed milk ducts (tubes), and the initial care is similar: nurse on cue, rest, and apply cold to the tender area.

DUCTS WITH SLOWED MILK FLOW

Milk flows through a duct system in your breasts. Sometimes inflammation of the surrounding breast tissue causes narrowing of the ducts which causes milk to stop flowing well. Depending on your skin tone, a section of your breast may or may not be redder than usual. If you have a duct where the milk is not moving freely, your breast will usually be tender, though the pain will be localized. If the inflammation is not addressed or allowed to rest, the area may become infected.

You may also hear people refer to clogged, blocked, or plugged ducts. Since there isn’t really a clog, blockage, or plug, all of these terms can be misleading.

Treatment for inflammation around the ducts is similar to that for mastitis. The following ideas may help provide relief:

• Apply cold to the area. Wrap a cloth around any ice to avoid irritating skin. A package of frozen vegetables or fruit can be a convenient, form fitting way to apply cold.
• Use the GENTLE therapeutic breast drainage technique. For more guidance, see this illustrated diagram of how to perform the lymphatic drainage technique or this video instead. The lymphatic drainage technique uses light sweeping of your skin and a very gentle touch, similar to the amount of pressure one might use to pet a cat.

• Make 10 small circles at the base of your neck, just above your collarbone.

• Make 10 small circles where your breast meets your underarm.

• Sweep from your nipple toward your chest, collarbone, and underarm.

• Avoid any deep massage or use of massaging tools such as an electric toothbrush or vibrator, which can aggravate inflammation.
• An appropriately fitting, supportive bra can be helpful, but avoid tight fitting bras that could compress tissue.
• Continue to nurse or express milk on demand, as you normally would to feed your child, but do not perform any additional milk expression, so as to avoid stimulating more milk production in the inflamed area.
• Check your positioning and attachment (latch) to help with effective milk removal and to stop the problem happening again.

If you have recurrent inflammation of the ducts that does not resolve with the suggestions listed above, check with your healthcare provider to see if medications, supplements, and/or dietary change recommendations would be appropriate. Treatments to discuss may include taking lecithin (3600-4800 mg lecithin per day, or 1 capsule [1200 mg] 3-4 times per day, gradually reducing dosage as symptoms improve) and/or taking probiotics containing specific strains of Ligilactobacillus salivarius or Limosilactobacillus fermentum. Dietary changes may include reducing saturated fat in your diet and/or reducing sodium (salt) intake (sodium that can cause fluid retention and increase susceptibility to infections of any kind).

Inflammation of the ducts can occur when your child’s ‘schedule’ becomes less predictable due to illness or life changes, meaning the child isn’t removing milk from your breasts as often as usual. If your child has recently started to sleep for longer periods at night or is nursing less due to teething, this can also leave you with overly full breasts. If this is the case, you can help avoid inflammation by ensuring you feed or express a little, to comfort only, in order to avoid further problems.

MILK BLISTERS (BLEBS)

A milk blister (or bleb) is usually a painful white dot on the nipple or areola resulting from the products of ductal inflammation working their way out to the surface and lodging there.

A milk blister is not the same as a blister caused by friction, either from an incorrect latch or a badly fitting nipple shield or breast pump flange. Milk blisters do not always hurt and may resolve over several weeks without any treatment. If you have a painful milk blister, you could try the following:

• Apply cold to your breast to reduce the inflammation in the tissue behind the bleb.
• Soak your nipple in warm water if it feels soothing.
• Wear a cotton ball soaked in olive oil in your bra to soften the skin.
• Consider asking your healthcare provider about taking oral lecithin supplements or applying a steroidal cream to the affected area.

If these don’t work, ask your healthcare provider for help. Avoid opening the blister yourself; it may bring relief but could also result in infection. If a blister comes open, you can help prevent infection by cleansing the wound with mild, unperfumed soap and rinsing well once a day.

MASTITIS

Mastitis (inflammation of the breast) can occur when you are producing more milk than your child needs or when the microbiome in your breast tissue is out of balance (dysbiosis), causing narrowing of the milk ducts. In addition to having a tender breast, you are likely to feel achy, run-down, and feverish; you may have flu-like symptoms.

This can progress to an infection if not treated. Delayed nipple wound healing, stress, chronic engorgement, and persistent breast pain increase the risk of mastitis. Milk production may drop in your affected breast for a few days during the worst of the symptoms, but it is important for your child to continue breastfeeding on cue from that side to help prevent the infection from turning into an abscess. Although some children might be a little more fussy about nursing because the mastitis milk tastes different, the milk from the affected breast will not harm your child.

If you have mastitis, you can try all of the treatments listed in the section on ”DUCTS WITH SLOWED MILK FLOW”, as well as the following care plan.

CARE PLAN FOR MASTITIS

Signs, Symptoms, and Treatment

If you:

• Can feel a hard sore lump in your breast
• Feel achy and run down
• Have a low grade fever (less than 38.4° C [101° F])
• Can see red/reddish patches on your breast (on lighter skin tones) 

Then:

• Rest as much as you can
• Continue to feed your child on cue from both breasts
• Apply cold for 10 minutes every 30 minutes, or as desired, to reduce inflammation.
• Apply heat if it brings relief from pain, but primarily focus on applying cold to reduce inflammation 
• Avoid topical products such as castor oil and epsom salts which can wear at the skin and contribute to swelling
• Ask your healthcare provider if you can use medications such as ibuprofen alternating with acetaminophen to reduce the inflammation and pain.

If:

• You do not see results or feel better in 8-24 hours
• You continue to run a fever or suddenly spike a high fever (38.4° C [101° F]) or higher
• Your breast becomes redder than usual, hot, and swollen
• You see pus or blood in your milk
• You see red streaks on your breast from the areola to the underarm
• A cracked nipple looks infected
• You have chills and continue to feel worse

Then:

• Call your healthcare provider
• If medication is prescribed, take the full course
• Rest and drink plenty of fluids
• Continue to nurse or express on cue on the affected side
• Contact your local LLL Leader or group, or find local support here, to help you find out what is causing the mastitis so that it does not recur

Note:

It is a myth that it is unhealthy for your child to breastfeed when you have a breast infection – the antibacterial properties of human milk actually protect your child from infection. Continuing to breastfeed normally when experiencing a sore breast, plugged duct or breast infection will speed recovery. In fact, it’s helpful to avoid extra nursing or pumping beyond what you would normally be doing to feed your child, and to avoid any aggressive squeezing or massaging, as these could worsen inflammation.

Nursing on cue helps to provide comfort, reduce inflammation and encourage opening of the blocked area. Many parents find that varying breastfeeding positions removes milk from all areas of the breast more effectively. For example, if you most commonly use the cradle hold, try the clutch (‘football’ or ‘rugby’) hold or lying down to breastfeed.

Rest is an important component in recovery from sore breasts, plugged ducts or breast infections. Try resting in bed with your child cuddled next to you. For tips on making your bed a safer place for your baby, follow the Safe Sleep 7 guidelines. Keep supplies such as diapers, toys, books, your phone, a drink of water nearby to minimize trips out of bed.

Applying wet or dry heat with a heating pad or hot water bottle to the sore area of your breast may help increase comfort. Many parents find that taking showers or baths and using the lymphatic drainage technique to be a relaxing treatment during a stressful time. 

Sometimes mastitis is the result of poor positioning and attachment, meaning your child doesn’t remove milk from your breast effectively, too much pumping, or overproduction. An LLL Leader can help you explore improvements you can make to help prevent the condition recurring.  Get local support.

RECURRING INFLAMMATION (“BLOCKED DUCTS”) AND/OR MASTITIS

In order to prevent future slowed milk flow or breast infections, you may find it helpful to be cautious of sudden long stretches between nursing sessions. When breastfeeding, periodically change your child’s position, while maintaining good positioning. Avoid using breast pumps and nipple shields unless needed and avoid removing more milk than what your child will need to eat so as not to create overproduction of milk. Maintaining general health through your diet and getting extra rest may help keep your breast from becoming sore again.

Mastitis most frequently recurs when the bacteria are resistant or not sensitive to the antibiotic you have been prescribed, when antibiotics are not continued long enough, when an incorrect antibiotic is prescribed, when the parent stops nursing on the affected side, when the initial cause of the mastitis has not been addressed, or when the balance of bacteria in your milk duct becomes greater than the organisms (flora) that keep the bacteria in check (such as overproduction or dysbiosis). If mastitis recurs, request that your healthcare provider conduct a culture and sensitivity test on your milk to discover exactly what organism is involved and what antibiotic will eliminate it. Many organisms are resistant to common antibiotics and repeated use of ineffective medications increases the risk of an abscess. Mastitis caused by methicillin-resistant Staphylococcus aureus (MRSA) is becoming more prevalent. Increased risk for hospital-acquired MRSA, a virulent and difficult to treat situation, is seen in those with a Cesarean delivery (C-section), administration of antibiotics in the peripartum period, those with multiple gestation, and those who have experienced in vitro fertilization. Outpatient infection with MRSA is also becoming more common.

OTHER CAUSES OF MASTITIS

Nipple shields can slow down milk flow and encourage infection. Use of pacifiers and artificial nipples can affect how a child sucks and contribute to nipple soreness and development of mastitis.

Some babies are reluctant to breastfeed or refuse the breast periodically, perhaps due to sensitivity or other factors. Irregular breastfeeding patterns may contribute to repeated breast infections. Your local Leader may be able to help you troubleshoot and determine possible causes for this.

Make sure your clothing isn’t too tight-fitting, paying special attention to your bra. A supportive, appropriately fitting bra can be helpful, but some bras and bathing suits, especially underwire types, may put too much pressure on your breast. Even a heavy shoulder strap purse or frequent use of a baby carrier can cause problems. Frequently changing sides with bags/purses or baby carriers may help.

The shoulder strap of a seat belt can also cause a sore breast. A too tight strap could apply pressure to your breast. Also, the shoulder strap’s pressure from a sudden stop may cause a sore breast. Other types of injuries can result in sore breasts such as a kick or hit from a rambunctious toddler. These may result in inflammation leading to blocked milk flow and so should be treated with rest, cold and on demand nursings.

Any history of breast surgery, breast lumps or injury to the breast can increase risk of infection.

RESOURCES

Mastitis – a Matter of Inflammation, LLL Canada

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

Medications and Breastfeeding, LLL USA

Lymphatic Drainage illustrated diagram, PhysicianGuidetoBreastfeeding.com

Lymphatic Massage Technique Video, The Institute for Breastfeeding and Lactation Education

Positioning and Latching, LLL USA

Tongue Ties and Lip Ties, LLL USA

When Breastfeeding Ends Suddenly, LLL GB

PERSONAL STORIES

Katelyn’s Story: Overcoming mastitis and tongue-tie, LLL USA blog

Fatimah’s Story: My Struggle, LLL USA blog

AJ’s Experiences: Mastitis and Abscesses, LLL USA blog 

Sarai’s Story: Latching and Milk Blisters, LLL USA blog

Weaning from the Pump, LLL USA blog

IS YOUR CONCERN OR QUESTION NOT COVERED HERE?

Please contact a local LLL Leader with your specific questions.

Medical questions and legal questions should be directed to appropriate health care and legal professionals.

Page updated October 2022

Resource partially adapted from LLLI materials.