Localised Breast Inflammation and Mastitis

Background

Mastitis is inflammation of the breast which can develop into a bacterial infection and affects up to 33% of lactating women.^3,5

Breast pain related to localised breast inflammation and mastitis is described as the most common and distressing symptom and can lead to a compromised maternal psychological state.⁵

Factors which may contribute to developing mastitis include:

• poor breastfeeding technique
• illness
• separation from infant
• increased breastmilk production.^1,4,7 

Mastitis can develop when early, localised inflammation in the breast tissue is not addressed promptly and effectively^1,6

Early management strategies for both infective and inflammatory mastitis are the same and follow three key principles:

• keep the milk moving
• avoid overstimulation
• reduce inflammation.¹

Localised breast inflammation may be described as ‘blocked ducts’ or ‘plugging’. There is no evidence to support the concept of a blockage.¹

Attempts to ‘unblock’ a duct have been associated with breast tissue trauma that may worsen inflammation and increase the risk of developing mastitis.¹ 

Prevention and treatment strategies should instead focus on developing breastfeeding technique, avoiding excessive breast stimulation and reducing inflammation.¹

Signs and symptoms

Women with localised breast inflammation may experience: 

• pain in the breast, especially during the milk ejection reflex
• a palpable lump or firm area in the breast
• tenderness over the affected area
• redness or darkening of the overlying skin
• no systemic symptoms.¹

Women with mastitis may experience: 

• systemic symptoms including a fever, chills, tachycardia and general malaise
• a red, swollen, painful segment of the breast which may feel hot to touch.¹

Prevention

• Exclusive, physiological breastfeeding (feeding the infant at the breast according to demand) is likely to prevent and resolve localised breast inflammation and mastitis.^1,7
• Ensure the infant is positioned and attached well to support efficient milk transfer.¹
• Support the infant to feed for as long as and as often as they would like to.¹
• Treat sore or damaged nipples early. ¹
• Start each feed on alternate breasts to promote milk removal from both breasts often.¹
• Avoid extended intervals between breastfeeds.¹
• If the infant is not breastfeeding well, express to replace missed breastfeeds.¹
• Avoid expressing or remove more milk than the infant needs.¹
• Avoid giving the infant any fluids except breastmilk, unless medically necessary.¹
• Rest, drink to thirst and eat a balanced diet.¹
• Handle the breasts carefully to avoid causing trauma to the tissues.¹
• If weaning, aim to do so gradually. ¹

Wearing a well-fitting and supportive bra. ²

Management

Prompt treatment

• Prompt treatment of early breast inflammation can help to stop the progression of symptoms. Treatment should begin as soon as a lump, sore spot or red area is identified on the breast and can be managed by:
  • continuing to breastfeed
  • encouraging the milk ejection reflex
  • treating inflammation.¹

Continue to breastfeed

• This prevents the breast from becoming overfull and helps to maintain breastmilk supply.
• Ensure the infant is positioned and attached well, and that they are breastfed as often as they need.¹
• Alternate the breast offered at the beginning of the feed so that both breasts have milk removed regularly.
• Expressing (by hand or with a breast pump) can help to keep the milk moving if the infant is not breastfeeding well.¹
• Breastmilk from the affected breast is safe for the infant to drink.¹

Encourage the milk-ejection reflex

• The infant may display fussy feeding behaviours if the flow of milk is slowed.¹
• Offer skin-to-skin in a comfortable position.¹
• Deep, slow breaths and soothing music may promote relaxation.¹
• Warming the breast or gently stroking towards the nipple before a breastfeed can trigger the milk ejection reflex.¹

Treat inflammation 

• Cool packs can be applied to the breast after a feed to relieve pain and inflammation.¹
• Common anti-inflammatory or analgesic medications may be helpful such as Ibuprofen and  Paracetamol.¹ 

Rest and recover 

• Rest, fluids and nutrition will support the recovery from mastitis.¹  
• Further medical support is recommended if symptoms do not begin to improve within 12 to 24 hours.¹
• Antibiotic therapy should be considered early if infective mastitis is suspected, or after 24 hours of conservative management if no improvement is seen. Breastfeeding should continue as normal during a course of antibiotics.¹
• Abreast abscess may form If mastitis is not treated promptly. This is an uncommon but serious complication which requires medical treatment.¹
• Women with recurring localised breast inflammation or mastitis may benefit from lactation support to assist with identifying any modifiable risk factors.¹ 

Information for families

Better Health Channel: Breastfeeding, mastitis and other nipple and breast problems

Raising Children Network: Blocked milk ducts (localised breast inflammation), mastitis and breast abscess

Australian breastfeeding Association: Localised breast inflammation ('blocked ducts)'

Royal Children’s Hospital, Kids Health Info: Breastfeeding

References

1. Australian Breastfeeding Association. Inflammation and mastitis [Internet]. Melbourne: Australian Breastfeeding Association; 2023 [cited 2025 Aug 28]. Available from: https://abaprofessional.asn.au/wp-content/uploads/PUB-BIRFactSheet-InflammationMastitis-V1-1-20230221.pdf
2. Children’s Health Queensland. Blocked milk ducts and mastitis [Internet]. Brisbane: Queensland Government; 2023 [cited 2025 Aug 28]. Available from: https://www.childrens.health.qld.gov.au/health-a-to-z/breastfeeding/blocked-milk-ducts-and-mastitis
3. Women and Newborn Health Service. Mastitis [Internet]. Subiaco (WA): Government of Western Australia, North Metropolitan Health Service, King Edward Memorial Hospital; 2024 [cited 2025 Aug 28]. Available from: https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Patients-resources/Mastitis.pdf
4. Deng Y, Huang Y, Ning P, Ma SG, He PY, Wang Y. Maternal risk factors for lactation mastitis: a meta-analysis. West J Nurs Res. 2021;43(7):698–708. Available from: https://journals.sagepub.com/doi/10.1177/0193945920967674
5. Lai BY, Yu BW, Chu AJ, Liang SB, Jia LY, Liu JP, Fan YY, Pei XH. Risk factors for lactation mastitis in China: a systematic review and meta-analysis. PLoS One. 2021;16(5):e0251182. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251182.
6. Mitchell KB, Johnson HM, Rodríguez JM, Eglash A, Scherzinger C, Zakarija-Grkovic I, Cash KW, Berens P, Miller B, Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine clinical protocol #36: the mastitis spectrum, revised 2022. Breastfeed Med. 2022;17(5):360–376. Available from: bfmed.org
7. Wilson E, Wood SL, Benova L. Incidence of and risk factors for lactational mastitis: a systematic review. J Hum Lact. 2020;36(4):673–686. Available from: https://journals.sagepub.com/doi/pdf/10.1177/0890334420907898.