Managing Mastitis
This blog was written by Christine MacSween, a physiotherapist with expertise in pelvic floor health and supporting breastfeeding moms and their babies. She assesses and treats both the baby (addressing head turn preference, torticollis and latching difficulties), as well as the mom (addressing painful or difficult latch, breastfeeding positioning issues, and breast issues). In this post she explains the overlapping conditions of mastitis, engorgement, and blocked ducts, and provides some tips and resources for managing them.
Click here and here to learn more about Christine.
Breast Anatomy 101
To understand what can happen in the breast, it helps to take a quick look at its anatomy. Milk is produced in the lobules, and it drains to the nipple through ducts. Surrounding the lobules and ducts are fat and connective tissues.
When inflammation occurs, it can affect any part of this system, and different issues will cause different patterns of swelling, pain, and symptoms.
Mastitis
Mastitis is a broad term that refers to inflammation in the breast. Although many people assume mastitis always involves an infection, this isn’t always (or even usually!) the case.
It typically develops when the breasts are engorged.
Engorgement
Engorgement occurs when the lobules are overfilled with milk, either because of:
Too much milk production, or
Poor drainage of milk from the lobules
Engorgement often occurs in the early stages, and can also develop later on.
Early-stage engorgement usually happens when the milk first comes in, typically 2-4 days after baby is born. The entire breast may feel firm, heavy, hot, and uncomfortable.
After that initial phase, localized engorgement can happen when one area of a breast becomes swollen. This often occurs in cases of high milk supply or when the breast isn’t being emptied fully or often enough.
In both cases, inflammation occurs in the surrounding tissues which leads to swelling that prevents milk from draining well. This can make the situation worse as more milk accumulates in the lobules, causing a cycle that can lead to mastitis.
Clogged Ducts
The term clogged ducts refers to what happens when milk cannot drain through the ducts.
While this can happen due to hardened milk accumulating in the duct, or trauma to the nipple, the most common reason that milk cannot drain through the ducts is engorgement, as described above.
When Is It an Infection?
True breast infections (infectious mastitis) are less common than we once believed—less than one-third of mastitis cases involve a bacterial infection.
Signs of a possible infection include:
Red or purple discoloration of the skin
Fever and chills
Muscle aches
Nipple damage (this is often the point where bacteria can enter)
It can be difficult to know whether antibiotics are needed given that mastitis without infection can still cause infection-like symptoms, such as fever and chills. If you’re unsure, it's best to check in with your healthcare provider or lactation consultant.
Can You Still Get Engorgement with Low Milk Supply?
Yes! People with low supply can still experience engorgement or mastitis, especially if:
There is nipple trauma affecting milk flow, as even smaller volumes of milk can cause swelling if milk can't drain properly, and/or
There is low breast storage capacity, which is determined by the number and size of the lobules and is not necessarily correlated to breast size.
Treatment & Relief
Address the Inflammation
Gentle lymphatic massage and breast mobilization techniques (see below) can reduce swelling and improve milk flow. Avoid deep or painful massage—this can make things worse. Applying cool packs (not warm!), and taking an anti-inflammatory medication such as Advil can also help decrease inflammation.
Drain the Milk
Once the inflammation has started to settle it’s important to get the milk to drain from the lobules. Nursing, hand expression, or pumping can help relieve the pressure and break the inflammation cycle. Only remove the amount of milk that baby needs, the goal is to decrease the overproduction that is causing the inflammation. Don’t go longer than 5-6 hours between milk removal sessions to avoid the accumulation of milk in the lobules that causes inflammation.
Seek Help if Needed
If symptoms like swelling, redness, and pain last longer than 12–24 hours, it’s time to seek support from a lactation professional or healthcare provider. If infection is suspected, antibiotics may be needed.
Prevent Future Issues
Going forward, it’s important to check baby’s latch to reduce nipple trauma and support regular and effective milk removal, through nursing, hand expression, or pumping. It’s also advised to wear comfortable, non-restrictive clothing.
Strategies to Decrease Inflammation & Increase Drainage
Lymphatic Massage
The lymphatic system helps the body remove excess fluid and waste. An effective way to decrease swelling when the breast is engorged, is to encourage drainage of fluid through the lymphatic system.
The lymphatic system doesn’t have a pump like the heart, so it relies on movement and gentle stimulation to drain fluid. For early-stage engorgement (especially around the nipple), lymphatic drainage massage can be incredibly helpful.
To do this:
Use very light strokes, like petting a cat
Massage away from the nipple, toward the armpit, neck, and along the ribs
This can be done by a trained therapist or taught for at-home use
After massage, allow milk to drain - by feeding, pumping, or hand expression.
Taping
Medical tape can be used to gently lift the skin and improve lymphatic drainage. It’s applied in a spoke-like pattern radiating out from the nipple.
Engorgement occasionally occurs in pregnancy, and this method is especially useful at this stage when you want to avoid nipple stimulation.
Helpful Resources
The team of Family Physician lactation experts at Well Fed West (our next door neighbours!) can support you through mastitis. They have a useful handout that can be found here.
For more information about lymphatic drainage massage techniques, visit Maya Bolman’s website. Maya is a pioneer in breast massage techniques. Her videos on breast gymnastics, massage, and hand expression are practical and easy to follow.
Christine offers lymphatic drainage. If she is unavailable (she is currently on sabbatical until June 2026) she recommends a couple of her colleagues: