Breast health: mastitis, lumps and what to check

This page covers two different things: lactational mastitis, which is common and treatable, and breast lumps, which are a diagnosis question.

Lactational mastitis is an inflammatory condition of the breast, usually in a breastfeeding woman, presenting as a red, hot, painful, wedge-shaped area with fever and flu-like aching. The management has changed over the years and the current approach is: keep feeding or expressing from the affected breast, because milk stasis is part of the problem; cold packs between feeds and warmth before; anti-inflammatory analgesia (ibuprofen); adequate fluid; and prompt medical assessment, because antibiotics are often needed and an untreated mastitis can progress to an abscess. The old advice of stopping feeding from the affected side is wrong and worsens stasis.

An abscess presents as a fluctuant lump with a high fever and marked systemic illness, and it needs drainage. It does not respond to antibiotics alone.

Non-lactational mastitis and periductal inflammation occur, usually in smokers, and also need assessment.

Breast lumps. The overwhelming majority are benign — cysts, fibroadenomas, and normal lumpy breast tissue. The point is that this cannot be known without assessment, and a new lump, a lump that is changing, a lump with skin dimpling, nipple inversion, nipple discharge (especially blood-stained), or a lump with axillary lymph nodes needs clinical assessment and usually imaging. The single most important sentence on this page: any new breast lump needs assessment, and a herbal preparation, a poultice, or waiting are all the wrong answer. Early breast cancer is highly treatable; delayed is not.

Breast pain. Usually cyclical and benign. Assessed if persistent, one-sided, or with a lump.

Galactagogues and mastitis do not mix. Fenugreek and other supply-increasing herbs in a woman with mastitis increase the stasis that caused it. Do not take a galactagogue to "flush out" a blocked duct.