Unmasking the Myths of Mastitis

Common breast issues whilst breast feeding are called Inflammatory Conditions of the Lactating Breast (ICLB) and cover a variety of different symptoms. Unfortunately, the occurrence of ICLB is the main reason for women choosing to cease breastfeeding. Therefore, it is extremely important that multidisciplinary, evidence-based care is given to women in a timely manner so that they can continue to breastfeed.

MYTH 1. Any pain or redness in your breast is Mastitis

There are actually different ICLB (not just Mastitis) which include:
  • Engorgement
  • Blocked ducts
  • Mastitis with or without infection
  • Breast abscess
Engorgement occurs in approximately 15-50% of women and is defined as overfilling of the breast with milk. Signs of engorgement include: hard, painful, tight breasts with any combination of inflammatory symptoms including redness, pain, fever and breast tension.
Blocked ducts may be caused if milk is not sufficiently removed from the duct causing the milk to stop flowing. When a duct is blocked, milk accumulates, resulting in a painful, sometimes hard, lump that may also be accompanied by local redness.
Mastitis is described as a hot, tender, swollen, wedge shaped area of breast associated with a temperature of at least 38.5°C, chills and flu- like aching symptoms. This has been shown to occur in around one third of breastfeeding women. First, Inflammatory Mastitis develops and then acute Bacterial Mastitis may follow. 
3% of women with Mastitis are likely to develop a breast abscess which presents as a hard, tender and potentially fluctuating mass with overlying redness.
All of these breast issues present with common signs and symptoms and not all women present with the same problems, severity or impact. It may look like mastitis but may not be, therefore individualised assessment with a trained health professional is essential. 
Risk factors for Inflammatory Conditions of the Lactating Breast include:
  • Previous episode of ICLB
  • Poor breastfeeding technique – poor positioning/attachment problems
  • Lowered immune status due to:
    • Stress
    • Sleep deprivation and fatigue
    • Poor nutrition
    • Anaemia
    • Poor hygiene
    • Maternal or infant illness
  • Delay in newborn feeding

Breast Inflammatory Symptom Severity Index (BISSI)

At Women’s and Men’s Health Physiotherapy (WMHP), we use a Patient Reported Outcome Measure (PROM) to help with diagnosis, treatment selection and clinical monitoring and provide you with the best care and management of ICLB. This PROM helps us by assessing the range and severity of your symptoms. This PROM is called the BISSI and allows you to clearly report the presence and severity of each symptom you are experiencing.1 This allows your Physiotherapist to directly address the specific symptoms that you present with. 
The BISSI not only assesses physical symptoms such as pain, redness, hardness, size of affected area but also your overall sickness and the impact that it is having on your life, which can be quite significant when breastfeeding. 

MYTH 2. You can’t prevent Mastitis from occurring


Management of ICLB includes general strategies for engorgement, blocked ducts and Mastitis as well as specific interventions. If effective treatment is provided promptly, it can halt the progression of symptoms. Many of these measures provide treatment and prevention.2
 Ways that we treat ICLB include2:
  • Addressing individual risk factors and referral to other health professionals such as lactation consultants, maternal child health nurses and GP’s
  • Reassurance that symptoms will resolve with conservative care and psychosocial support
  • Education on breast anatomy and breast feeding – it is important to keep feeding your baby from the affected breast
  • Positions for lactation
  • Advice regarding supportive and correct fitting bras
  • Recommendation to AVOID deep massage of the breast as it causes increased inflammation and breast tissue injury
  • Manual lymphatic drainage which is a light sweeping of the skin to assist milk flow. Your Physiotherapist can teach you this technique.
  • Avoidance of topical products such as saline soaks or castor oil
  • Use of ice and Nonsteroidal Anti-Inflammatory Drugs (NSAID’s) such as Nurofen which will reduce inflammation and provide pain relief.

How does Ultrasound help?

Ultrasound is a form of sound waves that is transmitted at a dose which assists in drainage of the breast ducts and reduces swelling and pain. Recent guidelines show that therapeutic ultrasound can be an effective treatment for ICLB and needs to performed under the supervision of a Physiotherapist on a daily basis until symptoms are relieved.2 At Women’s and Men’s Health Physiotherapy we prioritise women with ICLB and ensure you are seen quickly.

MYTH 3. You need to take antibiotics to treat Mastitis

The majority of ICLB present with similar symptoms so historically women were prescribed antibiotics quickly, especially if they had a fever. Now, we know that a fever is a symptom of inflammation not necessarily infection. Therefore, the use of NSAID’s is more effective for Inflammatory Mastitis, which is vastly more common than Infective Mastitis. Women and their health professionals need to be aware that taking antibiotics in the presence of Inflammatory Mastitis can actually increase the risk of progression to Bacterial Mastitis2. Research has shown that taking antibiotics just in case is not effective in preventing Mastitis2.
Our Physiotherapists understand all the physical and emotional demands on you when you are breast feeding and will provide the best evidence-based management for ICLB as well as providing the necessary support required to assist you to continue to breast feed.


1 Cooper M and Lowe H. Development of a novel patient focussed symptom severity index for us in assessing and treating inflammatory conditions of the lactating breast: a Delphi study. Int J Evid Based Healthc. 2020; 18:231-240.
2 Mitchell KB, Johnson HM, Rodriguez JM, Eglash A, Scherzinger C, Zakarija-Grkovic I, Cash KW, Berens P, Miller B. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum. Breastfeeding Medicine. 2022; 17(5): 360- 376.
August 2022