Mastitis Spectrum

Abrie McCoy, CLC
December 29, 2022

Clogged Ducts? Mastitis? Which one???

Female cartoon graphic grasping painful breast.

Let’s be upfront and honest, lactating can be a real let down (pun intended). It may be natural, but that does not always make it easy. There is so much information out on the world wide web. As well as science always evolving and changing. This includes breastfeeding medicine! Recently, there was a new protocol released by the Academy of Breastfeeding Medicine. Changing many of the recommendations surrounding engorgement, clogged ducts, and mastitis. Turns out, these conditions are considered a spectrum of conditions stemming from swelling in the breast. Don’t worry, we will break it down for you.

Cutting to the chase


  • Express breastmilk normally 
  • Wear a good fitting and supportive bra
  • Use ice as needed for inflammation and pain
  • Lymphatic massage


  • Soak breasts in saline or apply topical products
  • Use deep massage
  • Use heat

What is Mastitis?

In the new Academy of Breastfeeding Medicine Mastitis Protocol (#36), Mastitis is described as inflammation (swelling) of the mammary gland (breast) causing ductal narrowing. This has previously been described as “clogged” or “plugged” ducts. The truth is- there is not just one clog stopping milk from flowing. It is a reduction of the travel space your milk has to get through your breast. 

What causes ductal narrowing?

Typically milk stasis or prolonged periods without removing or effectively removing milk. This can lead to a “backup” of milk on top of the milk that your body is continuing to produce on a regular schedule. In turn aggravating your breast tissue and causing swelling- further reducing the amount of space that your milk has to travel. 

A great comparison to envision this in real life is an expressway. You only have 4 lanes to get so many cars through. However, at rush hour- there are so many cars that everyone is forced to go REALLY slow. 

Ductal narrowing example with a photo of a traffic jam.

Inflammatory Mastitis vs. Bacterial Mastitis

If milk continues to be backed up and swelling continues to decrease- you run the risk of inflammatory mastitis. Your milk ducts continue to have reduced travel space causing redness, swelling, and increased tenderness or pain. This does NOT indicate an infection though! How do we know the difference between inflammatory mastitis and bacterial mastitis? The timing. If these symptoms resolve in 24 hours- you can chalk it up to inflammatory mastitis. However, if these symptoms continue, it is most likely bacterial mastitis.  

Your breast has its own microbiome or collection of good bacteria. However, when milk is hindered from traveling through the breast ducts, the bacteria can be thrown off balance. The redness, swelling, and pain that may occur from the inflammation will continue and may even worsen. Along with fever and/or increased heart rate. If these symptoms continue longer than 24 hours we consider this bacterial mastitis and should be treated.


Graphic showing what to do in the case of breast pain, engorgement, clogged ducts, and or mastitis.

Treatment for the mastitis spectrum goes in steps at the first sign of ductal narrowing. Starting with continuing to nurse or express breast milk as you would normally- not adding on any additional stimulation (extra expression sessions). Because your breast milk production relies on demand to continue supply, by adding additional stimulation you could be inadvertently making the problem worse by “demanding” more breastmilk!

For pain, you can use ice and if appropriate, nonsteroidal anti-inflammatory drugs (NSAIDs) (please consult with your primary care doctor for safety!). You may also use “Lymphatic Massage”- the equivalent massage of petting a cat. You can do this by gently rubbing your chest area in circular motions along your collarbone and into your arm pit area. You may also do stroking motions away from your nipple and areola. Performing lymphatic massage can decrease swelling.

While heat may seem like the go to in a situation like this, avoid using it! Using heat can make your symptoms worse. The goal is to avoid making the swelling worse. If you use heat, it can increase blood flow to the area. You should also avoid massage! Adding increased pressure to the area can cause additional swelling- making your symptoms worse.

If your symptoms continue past the 24 hour mark, please reach out to your primary care provider to discuss antibiotic treatment. The good news is- mastitis is not contagious and your milk is still fine to give to your  baby! If you have any questions about antibiotic safety and breastfeeding- text us and we can get you set up with an appointment with a lactation professional who can guide you. 


This may sound over simplified- but to prevent the mastitis spectrum, continue to remove milk effectively frequently. This can follow your normal nursing or pumping routine. Typically about every 2-3 hours. It may also be helpful to wear a bra that is supportive and fits correctly. You can check out our blog about that here! Continuing to do lots of skin to skin and putting baby to breast also helps to keep your breast’s microbiome balanced and healthy!

If you have any questions, please feel free to text us at 888-458-1364 to get in touch with one of our lactation providers! 

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