Inflammatory Conditions of the breast

Blocked ducts, mastitis and other inflammatory breast conditions can be extremely painful and distressing for women. Symptoms can include pain, redness, tension or lumps and increased skin temperature of the affected breast as well as flu-like symptoms including fevers/chills and body aches. These symptoms can all suggest an inflammatory breast condition, however it can be difficult to confirm whether an infection is present, and whether that infection is bacterial or fungal. Carefully assessment is required and understanding your personal contributing factors can be extremely beneficial in preventing reoccurrence. Ie “Why did this happen and what should i be aware of next time/in future?”

What is it?

The term mastitis encompasses a spectrum of conditions and relates to inflammation of the breast tissue. Blocked ducts, mastitis and other inflammatory breast conditions can be extremely painful and distressing for women. Acute mastitis often occurs in the first 6-12 weeks when you're still trying to get your head around breastfeeding or pumping and regulate your supply (while also being sleep deprived, recovering physically and caring for a newborn!)

Research has demonstrated that multiple factors contribute to the development of mastitis. These include hyperlactation (your body making more milk than your baby needs), microbial factors such as diversity of the milk microbiome, and medical factors such as antibiotic use. This mammary dysbiosis relates to the healthy balance of good and bad bacteria in our bodies.

All of these issues can lead to narrowing of the ducts due to inflammation and swelling in the breast. "Blocked ducts" can present as a tender or congested segment of the breast. When this issue isn't resolved, surrounding inflammation progresses and inflammatory mastitis develops. It is this swelling in the breast that compresses the duct and makes it difficult for milk to flow. This can mean that your baby is fussy at the breast or you might be worried that your milk supply has decreased.

Why does it occur?

Ducts are very fine and sensitive, and can be compressed from seemingly innocuous things like poorly fitting pumps and bras, firm massage or physical trauma.

Having an oversupply of milk can sometimes be challenging too - we want to feed your baby regularly but not continue to increase your supply. Ideally, we want your milk production to be in sync with your baby's milk needs, and this can take a little time at the start. This might mean feeding on demand, avoiding missing or delaying feeds, waking a baby for a feed if your breasts are full, or expressing for comfort if needed. Out dated advice encouraging you to “drain the breast” might be perpetuating the cycle of hyperlactation and a risk factor for worsening tissue oedema and inflammation.

The latest theory around breast microbiome suggests that certain probiotics may be helpful

What to do if you experience breast pain

If you think you may have a blocked duct or mastitis, then seek treatment early and continue feeding or pumping to your normal pattern. We recommend a team approach:

• see your pharmacist or GP for anti-inflammatory medication (NSAIDs) and in case antibiotics are required

• see an IBCLC to address fit and hold issues and get individualised breastfeeding advice

• see a mastitis trained osteo or physio to relieve pain and address musculoskeletal factors

• utilise a partner, family or friends where possible to ensure that you're getting adequate rest & nutrition

Eureka Health treatment of mastitis may include:

• A detailed history assessing all aspects of your health and breastfeeding journey is important to identify potential contributing factors, confirm a diagnosis and avoid future episodes

• Effleurage or Lymphatic drainage massage: when inflammation develops, it isn’t just milk that is building up in your breast tissue. Improving drainage throughout the whole chest wall is important.

• Therapeutic ultrasound: aiming to decrease pain, improve blood flow and fluid movement and increase cell membrane permeability to any antibiotics prescribed without damaging the tissue.

• Treatment and home stretches to address any potential contributing tension through the chest, back and neck.

• Advice on breastfeeding positioning and education on self-management strategies (including self massage, stretching) for treatment and prevention of future occurrences.

• Liaison with your GP or IBCLC for referral for antibiotics, or imaging to rule out breast abscess if required

Prevention is better than cure!

Treat your breast tissue just like you would any other part of your body. Move it, stretch it and be kind to it!

Other tips include:

• Rest - keep your fluids up, eat well, rest when you can, and try to rope in some help with your baby. We need to support your body to recover and to improve your immunity.

• Stretch - gently open your chest, stretch your pec muscles, get your upper back and shoulders moving! This will help to get fluid moving around your chest wall.

• Be picky about your bras - avoid wearing underwire and assess your feeding singlets and bras to make sure they’re supportive but not compressing your breast tissue at all (remember breast tissue continues up into your armpit)

• Avoid self massage - Aggressive breast massage may damage the delicate ducts and increase inflammation. Learn how to get fluid moving in your whole chest and shoulder girdle to help with the drainage of not just milk, but blood flow and lymphatics too.

• Be aware of your feeding patterns. Feed on demand, but don't worry about "emptying" the breast. Sometimes we don't notice if feeds have changed or if time away from your baby has meant bigger gaps between feeds. Regular feeding from each breast in a pattern that suits your baby helps to match your baby's needs with your milk production.

• Minimise pumping. If you're pumping try to only pump the amount of milk that your baby needs. Hand express for comfort until your milk production down-regulates to match your baby's needs. If you are pumping or using nipple shields, there’s no need to sterilise them, simply wash in hot soapy water.

*Megan, Jacqui, Grace and Tamika are all trained in the treatment of inflammatory breast conditions. If you can’t find an appropriate appointment and are in urgent need, please call the clinic on 5333 2232

These recommendations are adapted from the latest Academy of Breastfeeding Medicine Mastitis Protocol #36, revised in 2022