The body quickly responds to mastitis by increasing blood flow to the area and activating bacteria-fighting systems. The area then becomes inflamed with swelling and pain. The swelling may block milk ducts both in the affected area and away from it, and pain may interfere with the let-down.
As a result, the breast may not empty well with breastfeeding or with expressing. That causes more swelling and pain, delays healing, and increases the risk of getting an abscess.
The most effective way to empty a breast is by breastfeeding when the baby is hungry, offering both breasts at each feed, and not favouring one side over the other.
Mothers can increase breast emptying by breastfeeding the baby to sleep on the breast with mastitis after the baby has breastfed on both sides. If only done for a few days until the mastitis has improved, these short and occasional feeds are unlikely to significantly increase the milk supply on the affected breast or decrease it in the normal one. If the breast with mastitis is very painful, they should use the unaffected one for this; again, this is unlikely to create significant changes in the milk supply of either breast.
Mothers can help their breast empty by using some of the gentler tools used to stimulate a let-down before feeding.
2) Warm and cold compresses
Early or mild mastitis might benefit from warm compresses before breastfeeding to help blood and bacteria fighting-white blood cells enter the breast.
Moderately to severely infected breasts are unlikely to benefit from this as the breast is already very warm. Rather such mothers may find cool cabbage compresses helpful in reducing pain and swelling.
3) Anti-inflammatory drugs
Anti-inflammatory drugs are compatible (pose little or no risk to the baby) with breastfeeding. They may reduce pain, fever, and swelling.
4) Warm water breast bath in a constant-suction pump
Breast fullness after breastfeeding or expressing in the area of the breast away from the site of the infection can be a sign that the breast is not emptying well.
In this situation, extra milk can be removed from the breast using a constant-suction pump filled with warm water. When the pump is attached to the breast, the nipple and central areola sit in warm water. This method uses the comfort of warm water to relieve pain and bring on a let-down and the suction created by the pump to draw out the milk. This is very gentle and, when done properly, is unlikely to add to a mother's pain. This can also soften the nipple root as it is slightly stretched in the pump.
5) Avoid breast massage
Mastitis can cause swelling of the nipple root, which can interfere with latching and may be treated with nipple root massage.
Otherwise, breast massage of the infected area is best avoided as:
- There is no evidence that it helps
- It will be painful.
- It may damage inflamed tissues and cause further pain and swelling.
- It may push infection into other areas of the breast.