A Pain In The Breast

Tips for preventing mastitis—and what to do if you get it

When Marcie Richardson first developed mastitis, she pretty much took it in stride. As an OB-GYN, she’d treated dozens of women for this painful breast infection and figured this would be her first and last bout. As it turned out, though, it wasn’t—not by a long shot. She had four more cases in 10 months. And she had the infection three times while breastfeeding her second child.

Richardson, who practices at Harvard Vanguard Medical Associates in Boston and is an instructor of obstetrics-gynecology and breastfeeding at Harvard Medical School, admits the infections tested her resolve to keep nursing. “Every time I got mastitis, I thought, ‘I can’t stand it, I’m going to quit,’ ” she says. “But I kept going, and I’m glad I did.”

Only about 1 in 4 women gets mastitis during the first 12 months of breastfeeding. And even if you are one of the unlucky few, rest assured that you’ll likely develop it only once—though, as in Richardson’s case, infections do sometimes recur. In the meantime, here are tips to help you avoid mastitis in the first place and different treatments in case you do have to deal with it.

How mastitis happens
Mastitis causes the breast tissue to become inflamed and infected. While it can occur at any time, the condition is most common during breastfeeding, when the ducts are filled with milk—a natural breeding ground for bacteria. But how do bacteria get into the ducts in the first place?

“Nipple trauma is a big culprit,” says Pamela Berens, M.D., an associate professor at the University of Texas at Houston and an OB-GYN at the University of Texas Health Science Center. “If a woman isn’t latching her baby on properly, a crack or opening in the nipple can result. This lets bacteria—which usually comes from the baby’s mouth—get in where they don’t belong.” Once the bacteria enter the nipple, they can travel up the milk duct and cause an infection in the breast tissue itself.

Clogged ducts are another culprit, and they can be caused by a number of factors. These range from wearing a poorly fitted bra to incomplete emptying of the breast during feedings, according to Richardson. “When the breast cannot drain properly because of an obstructed milk duct, the body’s usual infection-fighting strategies don’t work and bacteria can take hold,” she explains.

Berens, who is also a certified lactation consultant, likens this phenomenon to a bladder infection: Your urine is sterile, but if you’re not emptying the bladder, you’re more likely to get an infection. The same thing happens with breast milk. “Even though it’s bacteriostatic—meaning it doesn’t encourage the growth of bacteria—if milk isn’t draining well and is sitting in the ducts, bacteria are more likely to breed and grow,” she explains.