Last month, our Ask the Expert series discussed a few considerations around nipple pain when breastfeeding or breastfeeding, and how often this type of discomfort occurs. This month, our lactation team will discuss the questions around mastitisa painful swelling of breast tissue that can lead to fever, chills, and – if untreated – breast abscess and a potential need for surgical treatment (1). Like nipple pain, lactational mastitis is unfortunately common – about one in four breastfeeding women will experience mastitis in the first 6 months after giving birth. (2).
Mastitis can occur in conjunction with the type of nipple pain we talked about last month, but our understanding of its relationship to nipple damage, its causes, and the best way to treat it is changing. If you’ve been treated for mastitis in the past, you may find the Academy of Breastfeeding Medicine’s recently updated recommendations for mastitis management surprising!
The new ABM paper, published in 2022, describes how mastitis is no longer thought to be caused by a pathological entity. (3). Instead, evidence shows that mastitis encompasses a spectrum of conditions in the lactating breast (4). For those looking to learn more about the updated protocol, Bridgetown Baby’s Lead Lactation Consultant Sarah Longwell breaks down the key differences between the new and old recommendations and provides some key take-aways. fight for lactating parents.
“In the past, people thought that mastitis was cause through a plugged or blocked milk duct. Providers were taught that clumps of milk fat harden, resulting in obstructions around the flow of milk,” Sarah said. She continued, “but this paper tells us something else is going on.”
For Sarah, the main difference between the old and updated recommendations for mastitis management is not a question of What blocks the flow of milk, but why?
“This new paper shows us that instead of the flow of milk being blocked from the inside (by hardened milk fat, for example), there is an accumulation of bacteria, combined with something external that puts the pressure in the duct, causing the milk to clog.”
Turns out, that ‘something external’ could be inflammation. When the breast tissue becomes inflamed, the blood vessels inside the breast expand and swell. This inflammation puts external pressure on the milk ducts, which narrows them and results in stopping the flow of milk. For this reason, the updated protocol of the Academy of Breastfeeding Medicine considers inflammation a major risk factor for mastitis/ductal narrowing – and the protocol recommends focusing on inflammation in both the treatment and prevention of mastitis .
For Sarah, this approach made sense.
“Considering inflammation as a risk factor is very important,” he says, “because when we thought the duct was ‘blocked’ in the past, we actually recommended things that could make the inflammation worse — like heat, massage, vibration, pumping, extra nursing, etc.
Instead, Sarah recommends that lactating parents experiencing mastitis follow protocols that can help reduce inflammation in the breast tissue, such as “ice, cold packs, and gently massage to support lymphatic health.”
However, the most important mastitis-related recommendation for new postpartum parents is to recognize the signs and symptoms of mastitis and contact their primary care provider and/or ask for breastfeeding care It’s still early. With skilled support to assess the situation and guide appropriate treatment options, parents can move past mastitis – and learn what they can do to reduce their risks of future bouts.
Sources
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https://www.mayoclinic.org/diseases-conditions/mastitis/symptoms-causes/syc-20374829
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Mitchell, KB, Johnson, HM, Rodríguez, JM, Eglash, A., Scherzinger, C., Widmer, K., Berens, P., & Miller, B. (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The mastitis spectrum, revised 2022. Breastfeeding Medicine, 17(5), 360–376. https://doi.org/10.1089/bfm.2022.29207.kbm
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Pahwa R., Goyal A., Jialal I. Chronic Inflammation. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493173
