Mastitis

Diagnosis

Your healthcare professional does a physical exam and asks about your symptoms and medical history. You might have a breast ultrasound. Your healthcare professional might take out, called aspirate, some of the fluid in your breast. A culture of this fluid can help find the best antibiotic for you.

A rare form of breast cancer, called inflammatory breast cancer, also can cause redness and swelling that might be confused with mastitis. Your healthcare professional may suggest a mammogram or an ultrasound or both.

If your symptoms don't go away after you take a full course of antibiotics, you may need a biopsy to make sure you don't have breast cancer. Be sure to follow up with your healthcare professional after you've taken all the antibiotics.

Treatment

Mastitis treatment might involve:

• Antibiotics. If you have an infection, a 10-day course of antibiotics is most often needed. Take all the medicine. This lowers the risk of the infection coming back. If your mastitis doesn't clear up after taking antibiotics, contact your healthcare professional.
• Pain relievers. You can try a medicine available without a prescription such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).

It's safe to keep breastfeeding if you have mastitis. Breastfeeding helps clear the infection. Weaning your baby suddenly might make your symptoms worse.

You might see a specialist in breastfeeding, called a lactation consultant, for help and support. Advice on the best way to breastfeed might include:

• Don't let your breasts fill too much between feedings.
• Try get your infant to latch on well. This can be hard when your breast is swollen.
• Letting out a small amount of milk by hand before breastfeeding might help. This is called expressing.
• Lightly massage the breast while breastfeeding or pumping milk. Start at the affected area and move down toward the nipple. Do not press hard or squeeze.
• Make sure your breast drains all the way during breastfeeding. If you have trouble emptying your breast, put a warm, moist cloth on the breast before breastfeeding or pumping milk.
• Breastfeed on the affected side first. This is when your infant is hungrier and sucking harder.
• Change your breastfeeding positions.
• Drink plenty of fluids.

Breast-feeding: Cross-cradle hold

Breast-feeding can be awkward at first. Experiment with various positions until you feel comfortable.

The cross-cradle hold is ideal for early breast-feeding. Sit up straight in a comfortable chair with armrests. Bring your baby across the front of your body, tummy to tummy. Hold your baby in the crook of the arm opposite the breast you're feeding from — left arm for right breast, right arm for left. Support the back of the baby's head with your open hand. With the other hand, support your breast from the underside in a U-shaped hold. Guide the baby's mouth to your breast. Don't bend over or lean forward. Instead, cradle your baby close to your breast.

Breast-feeding: Cradle hold

The cradle hold is similar to the cross-cradle hold, but you support the baby with the arm on the same side as the nursing breast, rather than the opposite arm. As with the cross-cradle hold, sit up straight — preferably in a chair with armrests. Cradle your baby in an arm, with your baby's head resting comfortably in the crook of your elbow while he or she faces your breast. For extra support, place a pillow on your lap.

Breast-feeding: Football hold

Another option is the football hold. This position might be a good choice if you're recovering from a C-section or you have large breasts.

Hold your baby beside you, with your elbow bent. With your open hand, support your baby's head and face him or her toward your breast. Your baby's back will rest on your forearm. It might help to support your breast in a C-shaped hold with your other hand. For comfort, put a pillow on your lap and use a chair with broad, low arms.

Breast-feeding: Side-lying hold

A lying position might be a good choice when you're tired but able to stay awake — although it's important to return the baby to his or her own bed to sleep.

Lie on your side and face your baby toward your breast, supporting him or her with one hand. With the other hand, grasp your breast and touch your nipple to your baby's lips. Once your baby latches on, use one arm to support your own head and the other to help support the baby and bring him or her close.

Breast-feeding: Football hold for twins

If you have twins, you might choose to breast-feed them separately. This can be helpful when you are first starting to breast-feed. Later, if you'd rather breast-feed them at the same time, try the football hold — with one baby in each arm.

Hold each baby at one side, with your elbows bent. Your babies' backs will rest on your forearms. For comfort, put pillows on your lap and use a chair with broad, low arms.

Lifestyle and home remedies

To help yourself feel better:

• Don't let your breasts fill up with too much milk between breastfeeding sessions.
• Put a cool cloth or ice pack on your breast after breastfeeding.
• Wear a bra that supports your breasts.
• Rest as much as you can.

Preparing for your appointment

You may be sent to an obstetrician-gynecologist. For problems related to breastfeeding, you may be referred to a lactation consultant.

What you can do

Make a list of:

• Your symptoms, including any that may not seem to be linked to the reason you made the appointment, and when they began.
• All medicines, vitamins and supplements you take, including doses.
• Key medical information, including other conditions you have.
• Questions to ask your healthcare professional.

Questions to ask your doctor

• Will my mastitis clear on its own or do I need treatment?
• What can I do at home to relieve my symptoms?
• How might my condition affect my baby?
• If I keep breastfeeding, is the medicine you're prescribing safe for my baby?
• How long will I have to take the medicine?
• What are the chances that the infection will come back? How do I lower my risk of it coming back?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare professional might ask you:

• Are your symptoms in one or both breasts?
• How bad is your pain?
• How do you breastfeed?
• Have you had mastitis before?