Mastitis is a bacterial infection of the breast that usually occurs in breastfeeding mothers, needs to be differentiated from a plugged duct because a plugged duct does not need treatment with antibiotics, whereas mastitis often, but not always, requires treatment with antibiotics. A blocked duct presents as a painful, swollen, firm mass in the breast. Mastitis is usually associated with fever and more intense pain as well. However, it is not always easy to distinguish between a mild mastitis and a severe blocked duct. Both are associated with a painful lump in the breast. Without a lump in the breast, one cannot make a diagnosis of mastitis. A blocked duct can, apparently, go on to become mastitis.
Blocked ducts will almost always resolve spontaneously within 24 to 48 hours after onset, even without any treatment at all, can be made to resolve more quickly by:
1. Continuing breastfeeding on the affected side.
2. Draining the affected area better.
If the blocked duct is associated with a small blister on the end of the nipple, you can open it with a sterile needle. Opening the blister has the added benefit of decreasing nipple pain, even if the blocked duct does not immediately resolve. If a blocked duct has not settled within 48 hours, therapeutic ultrasound often works. Get the blocked duct re-evaluated at the clinic. Ultrasound also seems to prevent recurrent blocked ducts that always occur in the same part of the breast.
Here is my approach to dealing with mastitis.
1. If the mother has symptoms consistent with mastitis for more than 24 hours, she should start antibiotics. If, over the next 24 hours, the mother has not worsened, but not improved, she should start the antibiotics. However, if symptoms are starting to decrease, there is no need to start the antibiotics. If the course of your mastitis does not follow this pattern, contact the clinic.
2. Amoxicillin, plain penicillin, and some other antibiotics often prescribed for mastitis are usually useless for mastitis. If you need an antibiotic, it must be effective against Staphylococcus aureus.
Continuing breastfeeding helps mastitis to resolve more quickly. There is no danger for the baby. Heat applied to the affected area helps healing. Fever helps fight off infection.
An abscess occasionally complicates mastitis. You don’t have to stop breastfeeding to get a breast lump investigated. A breastfeeding friendly surgeon will not tell you that you must stop breastfeeding before she can do tests for a breast lump.