Mastitis

Also called Breast inflammation, Blocked duct

A painful, inflamed breast, usually while breastfeeding. The advice has changed: gentle handling and cold, not deep massage and heat.

What it is

Inflammation of breast tissue, most often during breastfeeding, causing a painful, red, swollen area, usually with fever and flu-like symptoms.

It generally begins as inflammation from milk stasis rather than as infection, and only some cases become bacterial. That distinction matters because it changes the treatment.

**The advice has changed significantly and much of what is still repeated is now considered harmful.** Deep massage of the affected area, applying heat, and aggressive extra pumping were standard advice and are now understood to worsen the inflammation and swelling. Current guidance is gentle handling, cold packs, anti-inflammatory medication, and feeding normally rather than emptying the breast aggressively.

Antibiotics are needed when symptoms do not improve in 12 to 24 hours with conservative measures, when there is a cracked nipple with obvious infection, or when the person is systemically unwell.

Untreated it can progress to a breast abscess, which needs drainage.

Mastitis also occurs outside breastfeeding, and in someone who is not breastfeeding, particularly with a persistent lump, skin changes or nipple discharge, inflammatory breast cancer must be excluded. A red breast that does not settle with antibiotics needs urgent referral, whatever the age.

Signs you might notice

A painful, hard, red or discoloured wedge-shaped area of the breast. On brown and black skin redness may be subtle; heat, swelling and pain are more reliable.

Breast feeling hot, swollen and tender.

Fever, chills, aching, and feeling flu-like.

Nipple damage or cracking, often preceding it.

Same-day: high fever, feeling very unwell, a fluctuant swelling suggesting an abscess, or symptoms not improving within 24 hours.

Urgent referral rather than more antibiotics: a red breast that does not settle, skin dimpling or thickening like orange peel, nipple inversion or discharge, or any of this in somebody not breastfeeding.

How it can affect day-to-day life

It is exhausting and demoralising, arriving in the newborn weeks when there is no reserve, and it is a common reason breastfeeding stops. Good support at this point often preserves it.

Pain makes people feed less on that side, which makes the stasis worse; feeding normally is part of the treatment.

Recurrent mastitis usually points at something fixable: latch problems, tongue-tie, an oversupply, a tight bra, pressure from a sling or car seat belt, or skipping feeds.

Nipple pain is not normal and is worth assessing properly rather than enduring; it is where the bacteria get in.

The out-of-date advice is still widely given by well-meaning people, and being clear about the change matters.

Supporting someone well

Feed or express as normally as usual. Do not empty aggressively or add extra pumping sessions.

Use cold, not heat, on the inflamed area.

Do not deep massage. Gentle handling and light lymphatic stroking towards the armpit only.

Take ibuprofen and paracetamol regularly; anti-inflammatory treatment is a core part of this, not just pain relief.

Rest and fluids.

Seek help within 12 to 24 hours if not improving, or sooner if very unwell.

Get the latch assessed to prevent recurrence, and check for tongue-tie.

For a red breast that does not settle on antibiotics, ask for urgent breast clinic referral rather than another course.

Where to get help

A midwife, health visitor or infant feeding specialist, and a GP practice for antibiotics.

Same-day GP or out-of-hours for high fever, feeling very unwell, or a suspected abscess.

The National Breastfeeding Helpline on 0300 100 0212.

Breast Cancer Now on 0808 800 6000 for breast changes that are not settling.