Blocked ducts and mastitis

A tender lump, a red, hot patch or flu-like aches while breastfeeding are common, and most settle with simple care. The advice changed in 2022. The Academy of Breastfeeding Medicine now sees blocked ducts, mastitis and abscess as stages of one problem, swelling and inflammation, and recommends gentler care than older advice.

What's happening

• Lumpy is normal. Breasts that are making milk often feel lumpy, and some fullness and soreness can be normal.
• Blocked duct. There's no single plug to push out. Swelling narrows many tiny ducts at once, leaving a tender, firm area with no fever.
• Mastitis. The area gets redder, more swollen and more painful, often with fever, chills and a fast heartbeat. This can happen without any infection. The NHS also lists a wedge-shaped lump and burning pain.
• Infection and abscess. If it keeps getting worse it can become a bacterial infection, and sometimes an abscess, a pocket of pus that needs draining. About 3 to 11% of people with acute mastitis develop one.

What helps

• Feed on demand, as usual. Don't try to empty the breast. Extra feeds or pumping on the sore side make more milk and more swelling.
• Pump only what your baby drinks, if you pump. Hand express a little for comfort if you need to.
• Ice on the sore area, as often as every hour. The NHS suggests a cold compress for 10 minutes every hour.
• Light, sweeping strokes over the skin (lymphatic drainage) can ease swelling.
• No deep massage, squeezing the lump, or vibrating devices. They add injury and swelling.
• A supportive bra that fits well.
• Heat can make swelling worse, though some people find it soothing.
• Pain relief. Anti-inflammatory pain relief can help. Ask your doctor or pharmacist which one is safe for you.
• Rest, and let others take on what they can.
• Leave nipple blebs alone. Popping a white dot on the nipple can make things worse.

Some NHS pages still suggest warmth and massaging the lump toward the nipple. The 2022 ABM protocol advises against deep massage because it can add injury and swelling.

Is breastfeeding still safe?

Yes. Milk from a breast with mastitis is safe for your baby. Stopping suddenly can make symptoms worse and may lead to an abscess. If you need antibiotics, only a very small amount gets into breast milk, and the NHS says there's no risk to your baby.

If the breast is so swollen that no milk comes out, feed from the other side until the swelling eases. Supply on the sore side may dip for a while and can build back later.

When to call your doctor

• No better 12 to 24 hours after home care.
• Breast pain with a fever, especially if the fever or a racing heart lasts more than 24 hours.
• Redness that spreads or gets worse.
• A firm or fluid-filled lump that keeps getting worse, which can be an abscess.
• No better 48 hours after starting antibiotics.
• Mastitis that keeps coming back in the same spot.
• You feel worse at any time. Get help the same day.

Rarely, mastitis leads to sepsis. Get urgent help: call 911 (999 in the UK) or go to the emergency department if you have confusion, uncontrollable shivering, very fast breathing, or pale, blue or blotchy skin.