Mastitis

Diagnosis

Your doctor will do a thorough physical exam and ask you about your signs and symptoms. A culture of your breast milk might help your doctor determine the best antibiotic for you, especially if you have a severe infection.

A rare form of breast cancer — inflammatory breast cancer — also can cause redness and swelling that could initially be confused with mastitis. Your doctor may recommend a mammogram or ultrasound or both. If your signs and symptoms persist even after you complete a course of antibiotics, you may need a biopsy to make sure you don't have breast cancer.

Treatment

Mastitis treatment might involve:

• Antibiotics. If you have an infection, a 10-day course of antibiotics is usually needed. It's important to take all of the medication to minimize your chance of recurrence. If your mastitis doesn't clear up after taking antibiotics, follow up with your doctor.
• Pain relievers. Your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).

It's safe to continue breast-feeding if you have mastitis. Breast-feeding actually helps clear the infection. Weaning your baby abruptly is likely to worsen your signs and symptoms.

Your doctor might refer you to a lactation consultant for help and ongoing support. Suggestions for adjusting your breast-feeding techniques might include the following:

• Avoiding prolonged overfilling of your breast with milk before breast-feeding.
• Trying to ensure that your infant latches on correctly — which can be difficult when your breast is engorged. Expressing a small amount of milk by hand before breast-feeding might help.
• Massaging the breast while breast-feeding or pumping, from the affected area down toward the nipple.
• Making sure your breast drains completely during breast-feeding. If you have trouble emptying a portion of your breast, apply warm and moist heat to the breast before breast-feeding or pumping milk.
• Breast-feeding on the affected side first, when your infant is hungrier and sucking more strongly.
• Varying your breast-feeding positions.

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 relieve your discomfort:

• Avoid prolonged overfilling of your breast with milk before breast-feeding
• Apply cool compresses or ice packs to your breast after breast-feeding
• Wear a supportive bra
• Rest as much as possible

Preparing for your appointment

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

What you can do

• Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
• Make a list all medications, vitamins and supplements you're taking.
• Write down your key medical information, including other conditions.
• Write down key personal information, including any recent changes or stressors in your life.
• Write down questions to ask your doctor.

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 continue to breast-feed, is the medication you're prescribing safe for my baby?
• How long will I have to take the medication?
• What are the chances that the infection will recur? How do I minimize my risk of recurrence?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:

• How long have you had signs and symptoms? Are they in one or both breasts?
• How severe is your pain?
• What is your breast-feeding technique?
• Have you had mastitis previously?