Categories: Breastfeeding, Postpartum, Pumping
April 29, 2025
Last updated on April 29, 2025
Mastitis is a common topic in support groups and can often be described in ways that sound overwhelming or even scary. In 2022, the Academy of Breastfeeding Medicine (ABM) released a new Clinical Protocol, The Mastitis Spectrum #36, to help individuals better understand inflammation, mastitis, and their treatment options. Below we explore the new guidelines and steadfast recommendations for anyone experiencing inflammation, engorgement, and/or mastitis.
Inflammation vs. Postpartum Engorgement
Inflammation occurs when the milk sacs within the breast become very full. It can be uncomfortable and can occur on one or both sides. While inflammation could lead to mastitis, it doesn’t always.
Postpartum Engorgement usually occurs between days 3-5 postpartum, when milk increases in volume during Lactogenesis II (the transition from colostrum to mature milk). It often affects both breasts and is caused by interstitial edema (extra fluid between cells, causing swelling) and hyperemia (a lot of blood vessels) in the area.
Mastitis: Inflammatory vs. Bacterial
All mastitis starts with the milk ducts narrowing due to inflammation, and this is referred to as inflammatory mastitis. If not addressed initially, it can develop into bacterial mastitis, which often requires further treatment options such as antibiotics. Bacterial mastitis can also develop through a wound on the chest, breast, and/or nipple.
What to Do if You Think You Have Mastitis
Know what is normal (and what’s not):
Everyone’s chest or breast anatomy can be slightly different, but some signs may suggest something’s off:
- New lumps or bumps within your breast
- New breast discomfort in specific spots
- Redness with no external cause (like rubbing or massage)
- Hot to touch in targeted areas
Important reminders
It is important to know that your milk, breasts(s), and feeding are all safe for your baby when you have mastitis! In fact, continuing to nurse is helpful to move the milk, even with bacterial mastitis. Your baby will not become sick from ingesting your milk while you have mastitis.
Although mastitis symptoms can come on quickly and can feel overwhelming, the best, and often hardest, thing to do is take a moment and not let yourself panic. Don’t hesitate to reach out to your lactation support (International Board Certified Lactation Consultant/IBCLC) with questions, but note that if you require antibiotics, those will be prescribed by your OBGYN/midwife/primary care provider. If possible, plan ahead and keep a list of best contacts for future concerns. Less to figure out in the moment!
Keep track of your symptoms – when they start and any changes you know of leading up to the start of symptoms (like a new bra, missed feedings, or a change in schedule).
On-demand feeding
Mastitis and inflammation are often uncomfortable, but it is important to continue to nurse your baby on demand or follow your typical schedule as closely as possible. Do not space out any feedings or pumping sessions as this can make symptoms worse.
Pumping considerations
If you can avoid pumping and limit stimulation to direct nursing only, this may help reduce the chance of breast or nipple injury. If you are not able to avoid pumping, make sure to pump only to maintain supply and not to fully empty your breasts as this can make symptoms worse.
Often, people will use their pump at a higher strength to try to “move” or “release” any milk they feel is “stuck,” but this is actually not a helpful practice. Using a strength that is too high can possibly cause pain, damage, and/or worsen inflammation.
As always, ensure you are using the correct flange size for your body. Using a flange that is too large could cause more pain, damage, and/or make your symptoms worse.
Cold vs. heat
Heat was often recommended as a primary tool to help soothe discomfort due to inflammation and mastitis. The new guidelines recommend using cold therapy to help reduce inflammation and pain.
Warmth can still be used if you find it helpful or comforting, such as taking a warm shower, but with moderation.
The shift from heat to cold stems from concerns that heat may increase inflammation, potentially worsening mastitis symptoms.
Bra Fit & Comfort
Bras – whether standard, nursing, hands-free pumping, or combo options – can be incredibly helpful during your lactation journey. But if they do not fit correctly, they can work against you. Your bra shouldn’t feel too tight on your breasts or around your chest. Extra compression can disrupt normal milk flow by putting pressure on your milk ducts, potentially leading to inflammation. If you are uncomfortable in your bra, it’s best to swap it out.
Underwire bras should also be avoided if they are too small or if the wire is digging into your chest or breast tissue.
Massage & Hands On Pumping
Avoid any deep massage to your chest, breasts, or nipples if you are experiencing inflammation or mastitis, as this could worsen inflammation and potentially cause further damage. Instead, gentle massage and hands-on pumping are great for helping move the lymph fluid within your breasts and helping reduce inflammation.
Cleaning & Sterilization
No need to change your routine for cleaning or sterilizing your pump and bottle parts if you have mastitis. You can follow the standard recommendations found in your pump user manual or the CDC guidelines.
If you suspect engorgement or mastitis, especially if you have symptoms that persist for more than 24 hours, reach out to your OBGYN, Midwife, or IBCLC for more info or support. You know your body best – trust that and reach out when something doesn’t feel right.
References
For additional guidance and to explore the full recommendations mentioned in this blog, check out:
- ABM Parent Handouts – Academy of Breastfeeding Medicine
- ABM Clinical Protocol #36: The Mastitis Spectrum (2022, Revised)
*This updated protocol replaces Protocol #4 (Mastitis) and Protocol #20 (Engorgement).