The Mastitis Spectrum: What You Need to Know

Mastitis isn’t just one thing, it’s a whole range of breast conditions that can make feeding uncomfortable, frustrating, or downright painful. The good news? With the right care and support, most cases can be eased at home.

This is a friendly, research-backed guide to help you understand what’s going on, based on the latest Academy of Breastfeeding Medicine Clinical Protocol #36. I’m using ‘breast’ and ‘breastfeeding’ here to match the ABM language, but please use the words that feel right for you, chest, chestfeeding, bodyfeeding, they’re all valid.

How your breast works

Inside your breast are tiny milk-making sacs called alveoli. They send milk through a branching network of milk ducts to the nipple. If those ducts become inflamed or narrowed, milk can’t move freely. This can lead to swelling, tenderness, or other symptoms.

The mastitis spectrum

• Engorgement

Usually happens in the first days after birth when your milk comes in. Breasts may feel very full, heavy, and tight, possibly hot to touch. Feeding baby often and on demand is usually the best fix. A cold compress can help soothe inflammation.

• Blocked ducts (ductal narrowing)

A milk duct becomes inflamed or narrowed, causing a small, firm lump and sometimes mild redness. There is usually no fever.

• Inflammatory mastitis

If a blockage worsens, inflammation can cause redness, heat, swelling, and pain, often with chills or fever. This isn’t always an infection – it may be inflammation only.

• Bacterial mastitis

An actual infection that may need antibiotics. Look for redness, swelling, and flu-like symptoms that continue for more than 24 hours. You can usually keep feeding safely while being treated.

• Abscess

A pocket of infection (pus) that can develop if bacterial mastitis isn’t treated or doesn’t respond. This needs medical assessment and drainage.

• Galactocele

A milk-filled cyst from a blocked duct. Usually painless unless it becomes infected.

• Recurrent or subacute mastitis

Mastitis that keeps coming back, often linked to oversupply, incomplete treatment, or changes in your breast’s natural bacteria (microbiome).

Milk bleb.

A milk bleb (or blister) is a small white or yellow spot, usually on the tip of the nipple, caused by a duct blocked right at the surface. It can be painful and may be linked with inflammation deeper in the breast.

Tips for caring for a milk bleb.

• Keep feeding or expressing as normal to keep milk moving.

• Some people find sunflower or soya lecithin helpful, especially if they have recurrent blocked ducts. Typical doses used in breastfeeding are around 3.6–10 g a day, but evidence is limited and it is not suitable for everyone. Speak to your GP or pharmacist before starting any supplement, and an IBCLC or breastfeeding counsellor can help you look at underlying causes of recurrent inflammation.

• If you have white soft paraffin, petroleum jelly, coconut oil, or another simple moisturiser at home, you can use a small amount to help soften the skin. Olive oil can be used, but it should be wiped off before a feed as it can thin the skin and isn’t ideal for a baby’s delicate skin. Soak a piece of cotton wool in warm water, add a little moisturiser, and place it inside your bra over the bleb before a feed. A warm compress before feeding (Epsom salts can help if you have them) may also soften the skin..

• If it worsens, becomes very painful, or doesn’t heal, get it checked.

Caring for mastitis at home

Most cases improve with gentle, consistent care:

• Feed on demand, responsively - don’t try to “empty” the breast completely.

• If you feel very full, hand express just enough for comfort.

• Avoid nipple shields unless a skilled breastfeeding supporter or health professional suggests and supports their use.

• Wear a comfortable, supportive bra that isn’t too tight.

• Skip hard, deep breast massage, gentle skin stroking and light compression are safer and less likely to worsen inflammation. some people find lymphatic drainage helpful, be gentle like caressing your baby's face https://www.youtube.com/watch?v=24MAkakR5k8

• For pain or swelling, ibuprofen and paracetamol are usually considered breastfeeding-safe when taken as directed. https://www.breastfeedingnetwork.org.uk/factsheet/analgesics/

• Try cold compresses after feeds for relief.

• Rest as much as you can and stay hydrated.

• If you have oversupply, seek support from an Breastfeeding Counsellor, Breastfeeding & Lactation Specialist, or an experienced Peer Supporter.

When to get help?

See your GP or another healthcare provider promptly if:

• You’ve had flu-like symptoms (such as fever, chills, aching) for more than 24 hours

• Pain, redness, or swelling is getting worse instead of better

• You have a lump that doesn’t improve over a couple of days, even with good feeding and self-care

• You suspect an abscess (a hot, very painful lump, sometimes with feeling very unwell)

• Mastitis keeps returning or never fully settles

Antibiotics and probiotics

• Antibiotics are only needed for bacterial infections. They won’t help simple inflammation on their own.

• Overusing antibiotics can upset your breast’s natural microbiome and contribute to antibiotic resistance.

• Certain probiotics may help prevent or support recovery from mastitis in some people. An IBCLC, pharmacist, or healthcare professional can guide you on which products and strains may be appropriate.

Taking care of you

Mastitis can leave you sore, tired, and low in spirits. You might feel fed up, worried about your milk supply, or anxious about feeding. All of these feelings are completely understandable.

You are not alone. Support is available from:

• GPs and practice nurses

• Midwives

• Health visitors

• Breastfeeding counsellors

• Lactation Consultants (IBCLC) other lactation specialists & Trained Peer Suppoters

• The National Breastfeeding Helpline 0300 100 0212 and local breastfeeding support groups.

In short

Mastitis can range from mild swelling to serious infection, but with early care and the right support, most people recover well. Feed responsively, care gently for your breasts, and reach out for help if things don’t improve or you’re worried.

This information is based on the Academy of Breastfeeding Medicine Clinical Protocol #36 (The Mastitis Spectrum) and other current, evidence-based breastfeeding guidance. https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf

Marion Frey-AlQurashi Mindful Breastfeeding Practitioner & Certified Lactation Specialist.