In the first few days of breastfeeding, as your milk “comes in”, you may feel fullness, heaviness, warmth and tenderness in your breasts. With frequent breastfeeding, this period of breast fullness should begin to improve in a few days as your body adjusts to making the right amount of milk for your baby.
Symptoms that include a firm reddened area in your breast may indicate mastitis. There are two types of mastitis.
Inflammation of the breast usually caused by inadequate or infrequent milk removal. This can happen with ineffective or infrequent breastfeeding, or as the result of a plugged milk duct. Pain may be present all the time or only with breastfeeding. If you are nursing frequently, and your baby is removing milk well, you may have a plugged milk duct. When milk builds up in the milk gland(s), an area of the breast can become red and tender.
Examine the problem area of your breast. Is there pressure from your bra or other clothing? When you support your breast during feedings, do you always place your thumb or fingers in the same spot on your breast? A plugged duct may be the result of pressure being applied to the breast that interferes with emptying during feeding. Moist heat and gentle massage just prior to and during breastfeeding may unplug the duct. If that doesn’t work, inspect your nipple for a “milk blister”. A thin layer of skin can cover the nipple pore, and may look like a white blister. Carefully peel the blister off of the nipple pore with a sterile needle. Nurse the baby or pump. Once the skin is opened and the plug is dislodged, milk may flow forcefully as the pressure is released. You should feel instant relief but the area may be tender still. After nursing, wash the nipple with mild soap and warm water, and allow a drop of milk to air dry on the nipple.
If you have a plugged duct that has not resolved in 24 hours, seek professional help. If milk stays in the breast, an infection can result. Infectious Mastitis Breast inflammation that is due to a bacterial infection. In addition to redness and a lump, a low-grade fever (99 to 101 F), body aches, chills and fatigue may be present. Immediate treatment with antibiotics is necessary to prevent complications from mastitis, which can include breast abscess. Early treatment may prevent a reduction in your milk supply.
This is a medical emergency! Call your doctor!
Physicians rarely call in medication without seeing the patient, but if you call your physician and describe what sounds like infectious mastitis, they will call in an antibiotic for you pronto and then see you in the office at the earliest opportunity.
The worst thing you can do when you have mastitis is to stop breastfeeding. Frequent nursing is the best way to preserve your ability to produce milk in the affected breast, and the milk is safe for the baby. If nursing is too painful, hand express or pump, but make sure you keep the breast drained to reduce the risk of complications. Mothers who have had mastitis in the past can be at higher risk for a reoccurrence, especially if the infection has resulted in scarring inside the breast. With your physician’s approval, use ibuprofen and frozen peas for comfort. Applying moist heat for a few minutes before nursing or pumping may help with milk flow, but remember that heat can increase inflammation.
Most cases of mastitis occur in the first 3 months, but it can happen at any time. Breast infections are most often the result of staphylococcus bacteria that are always present on our skin and protect us from harmful bacteria. If these friendly germs enter into the body where they don’t belong, infection can result. Always wash your hands carefully before handling your breasts to prevent the chance of introducing any germs that could cause infection. To prevent bacteria and yeast growth, routinely sterilize pump parts, pacifiers, and anything that comes in contact with your breasts or your baby’s mouth. The CDC has guidelines for cleaning your pump parts here