by Jack Newman, MD, FRCPC
Mastitis is a bacterial infection of the breast that usually occurs in breastfeeding mothers. However, it can occur even in women who are not breastfeeding or pregnant, and can occur even in small babies, of either sex. Nobody knows exactly why some women get mastitis and others do not. Bacteria may gain access to the breast through a crack or sore in the nipple, but women without sore nipples also get mastitis, and most women with cracks in the nipple do not.
Mastitis needs to be differentiated from a plugged or blocked duct, because the plugged or blocked duct does not need treatment with antibiotics, whereas mastitis often, but not always, does require treatment with antibiotics. A blocked duct presents as a painful, swollen, firm mass in the breast. The skin overlying the blocked duct is often quite red, similar to what happens during mastitis, but less intense.
Mastitis is usually also associated with fever and more intense pain as well. However, it is not always easy to distinguish between a mild mastitis and a severe blocked duct. A blocked duct, can, apparently, go on to become mastitis. Both are associated with a painful lump in the breast. Without a lump in the breast, one cannot make a diagnosis of mastitis or a blocked duct. A blocked duct can, apparently, go on to become mastitis. In France, physicians also recognize something they call lymphangite that is fever associated with skin which is hot and red, but there is no underlying painful mass. They do not believe this requires treatment with antibiotics. I have seen a few cases that fit this description in my practice, and indeed, the problem resolves without antibiotics. But then, often so does full blown mastitis.
As with almost all breastfeeding problems, a poor latch, and thus, poor draining of the breast sets up the situation where mastitis is more likely to occur.
Blocked Ducts
Blocked ducts will almost always resolve spontaneously within 24 to 48 hours after onset, even without any treatment at all. During the time the block is present, the baby may be fussy when nursing on that side, as milk flow may be slower than usual, probably due to pressure causing collapse of other ducts.
Blocked ducts can be made to resolve more quickly by:
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