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Photo: Evangeline and Ruth Courtesy of Sally Hobson Photography
Breastfeeding is normal and natural but how to do it is something we often learn from our mothers, sisters, and peers. Where we have lost the art of breastfeeding over several generations, new mothers’ nursing attempts can be easily sabotaged by misinformation. If little bumps in the road are not smoothed out, problems can escalate until weaning sometimes seems inevitable. This article looks at solutions to some of the soreness, lumps, and bumps that you as a breastfeeding mother might suffer and tackles some common myths about mastitis.
The most usual cause of nipple damage for a breastfeeding mother is when your baby isn’t latched properly to the breast or if your baby isn’t using his tongue properly, perhaps due to high muscle tone or a tight frenulum (the membrane under the tongue). In these circumstances, your nipple gets pinched and rubbed against the baby’s hard palate, and blisters, cracks and grazes will quickly appear. Once nipples are damaged, you are more vulnerable to mastitis or bacterial or fungal infections of the nipple. See Causes of Sore Nipples for a guide to the main reasons nipples can get sore and What Can I Put on Sore Nipples? discusses treatment ideas.
If possible, of course, it’s better to avoid getting sore and damaged nipples by asking for help early on from your LLL Leader or an International Board Certified Lactation Consultant (IBCLC).
Engorgement and mastitis: smoothing out the bumps
What is an engorged breast?
Engorged breasts are breasts that are very full with milk. Engorgement is a natural process that happens a few days after the birth of a baby when your milk supply “comes in.” With frequent feeds, good positioning, great latch, and an understanding of breast storage capacity, engorgement is not normally a problem in the early days and it signals a healthy milk supply. However, if your baby is not latching well, your breasts may become overly full, which can happen at any time in the breastfeeding relationship.
At the first sign of uncomfortable engorgement, expressing enough milk to be comfortable again will prevent the situation getting worse. Trying to work out why it happened will help to avoid its happening again (for example, if your baby was poorly and not feeding well, or had slept longer than usual). Your LLL Leader or IBCLC can help you identify what may have caused the engorgement and suggest improvements for positioning or latch.
By keeping swollen breasts drained, with the help of massage, cold therapy, and anti-inflammatory medication, you can avoid getting mastitis or worse, an abscess. See Engorged Breasts for more tips to relieve engorgement (including whether or not to use a pump and how to help baby when a breast is so engorged that your baby can’t latch on). When engorgement is very severe a mother may find it very difficult to get her milk flowing. See Engorgement Relief When Milk Won’t Flow for a comprehensive discussion of tips in this situation.
What is a blocked duct?
Breast milk is made and stored in milk-producing cells called alveoli and carried towards the nipple by little tubes or ducts. If one of the ducts is clogged or plugged with thickened milk the tube becomes blocked. The milk behind the blockage has nowhere to go and the build up of milk creates a sore lump in the breast. Blocked ducts are often quickly resolved by your baby breastfeeding well on the breast with the blockage, once careful attention is paid to positioning and latch. If not, gentle pressure and massage of the lump during a feed often helps to clear it. In Blocked Duct Nikki explains how she quickly resolved her plugged duct with her Leader’s help and there are more ideas in Blocked Milk Duct.
What is mastitis?
Mastitis is a painful inflammation of the breast. It will usually follow a period of unresolved engorgement. There may be a lump in the breast, flushing on the skin of the breast, and you may have flu symptoms such as shivers, a high temperature, and generally feel unwell. Fever symptoms tend to occur with or without a bacterial infection alongside—it is the body’s reaction to milk proteins (cytokines) leaking into surrounding tissues when breast milk cannot drain away. A bacterial infection may follow without prompt action to empty the breast.
Mastitis is more likely to happen if one or more risk factors are present, for example a damaged or cracked nipple, blocked milk ducts or nipple pore, or prolonged engorgement. Presence of insulin dependent diabetes mellitus may also be a precipitating factor (Walker, Breastfeeding Management for the Clinician 2013).
At the first sign of mastitis, it is important to relieve any engorgement with frequent feeds/expressing with massage and breast compression for thorough breast drainage. Cold therapy can reduce inflammation between feeds, and suitable anti-inflammatory medication will help both pain and inflammation. See Mastitis Symptoms and Treatment for further information.
Dispelling mastitis myths
Can you continue to breastfeed from a breast with mastitis?
Yes! You can continue to breastfeed. It is important to keep the breast drained of milk. Most mastitis isn’t infective but even if you have a breast infection, there isn’t any evidence to suggest it isn’t safe to carry on breastfeeding (Mohrbacher, N. Breastfeeding Answers Made Simple, 2010; Academy of Breastfeeding Medicine, 2014).
If you have mastitis will you need antibiotics?
No, you will not necessarily need antibiotics especially if symptoms are mild and are improving with mastitis treatment. However, if you aren’t starting to feel better after 12-24 hours or if symptoms are severe, then you should see your physician to discuss antibiotic treatment (Academy of Breastfeeding Medicine, 2014).
Can tightening your bra help mastitis?
No. A supportive bra may help comfort levels, but tightening a bra and not pumping to comfort will likely make the engorgement worse, with a high risk of mastitis (if that isn’t already the problem) and a risk of reduced milk supply. Wearing a tight bra or other tight clothing is a common cause of mastitis because it restricts the milk flow.
Will expressing through mastitis make the problem worse?
No. It is important to keep the breast drained during a bout of mastitis. At other times, over-pumping could over-stimulate the breast to make more milk than is needed, which could cause engorgement and mastitis. During a mastitis episode it is important to breastfeed often or pump to comfort if your baby can’t keep up with the milk removal.
A rare complication of neglected mastitis is the formation of a breast abscess. An abscess is the body’s way of protecting itself from infection by sealing off the area. The center of the abscess contains waste material or pus that is involved in trying to deal with the infection. This is most commonly due to Staphylococcus aureus (a bacteria). Once this pocket of infective pus is walled off deep in the breast however, there is nowhere for it to drain to the outside to allow healing. Different treatment options depend on the size of the abscess, and may include a course of antibiotics alongside either needle aspiration, catheter drainage, or surgical incision and drainage. For further information on treatment options and symptoms of a breast abscess see Do I Have a Breast Abscess?
A sore lump in the armpit
A lump in the armpit is quite possible when you are engorged because breast tissue extends into this area, which is called the tail of spence. Using the ideas in Engorged Breasts will help this engorgement to subside. Sometimes breast tissue in the armpit or other parts of the body along the “mammary ridge” can become engorged initially after birth, with no outlet for the milk. By using cold compresses these areas will ‘get the message’ to stop milk production.
An unexpected lump in the breast that seems to come and go according to how full the breast is could be a galactocele. This is a milk-filled cyst and can be diagnosed by ultrasound or by taking a little sample of material from the center of the cyst. The contents will be thicker than milk and more like butter. This type of cyst is not usually painful and will resolve after breastfeeding ends. Draining the cyst is possible but it often just fills up again.
If you have concerns about any mysterious lumps that don’t resolve quickly, check them out with your health practitioner. Although very rare in a breastfeeding mother, it is important to rule out any possibility of breast cancer, and most diagnostic tests are compatible with breastfeeding. See Breast Lumps for more information.
Support is key
If you are struggling with breastfeeding, getting good help and support is the key to overcoming any of the difficulties listed above. There are nearly always breastfeeding solutions to breastfeeding problems. Contact your LLL Leader or IBCLC as soon as possible in the event of any problems and they will help you to get breastfeeding back on track.
Philippa Pearson-Glaze has been an LLL Leader since 2002 and an International Board Certified Lactation Consultant since 2011. She lives in the West Midlands, United Kingdom, with her husband and four nearly grown children ages 12 to 21. She is Managing Editor for LLLI publication Leader Today and currently serves on the Professional Liaison panel for La Leche League Great Britain. Philippa also regularly writes for her informational website Breastfeeding Support.
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