Treating Mastitis – An Updated Guide for South African Moms

“I’ve never felt that terrible before,” is something many breastfeeding mothers say after experiencing mastitis.

Mastitis refers to inflammation of the breast tissue and can cause pain, warmth, swelling, and redness. It often affects one breast but may occur in both. In 2022, the Academy of Breastfeeding Medicine released an updated protocol that changed how professionals understand and treat mastitis and related breast complications.

This article forms part of our series on Engorgement, Mastitis, and Breast Tissue Complications. Please follow the hyperlinks or browse our library for more content on this topic.

What Is Mastitis and How It Develops

Mastitis literally means “inflammation of the breast.” It can result from engorgement that triggers an inflammatory response, leading to pain, swelling, and occasionally flu-like symptoms such as chills, fever, and body aches.

• When inflammation begins, your immune system sends inflammatory markers to the breast’s rich blood supply — that’s when you feel unwell.
• If not treated correctly, inflammatory mastitis can progress to bacterial mastitis, where infection develops.
• If bacterial mastitis is ignored, it may lead to a breast abscess requiring drainage or surgery.

Important: Fever doesn’t always mean infection. In early stages, inflammation alone may cause fever. Antibiotics aren’t helpful until infection is confirmed.

Also, remember that hormonal changes shortly after birth may cause sweating, warmth, anxiety, and heart palpitations — symptoms that can mimic mastitis. Always discuss your symptoms with a healthcare provider.

Read more on what happens inside your breast when you develop mastitis.

First-Line Mastitis Treatment South Africa: Gentle, Supportive Care

The first step in treating any form of mastitis — inflammatory or bacterial — is to support your body’s natural healing process.

1. Rest and Nurture Your Body

Don’t lose hope. With proper care, you can recover and continue breastfeeding.
Stay in bed with your baby, rest, eat nourishing food, and drink plenty of fluids. Your goal is to help your body rebalance naturally.

2. Continue Feeding — but Don’t Force Emptying

Both inflammatory and bacterial mastitis are not reasons to stop breastfeeding.

• Ensure a proper latch; if you experience nipple pain or difficulty, contact a certified lactation consultant immediately.
  You can email info@allthingsbreastfeeding.co.za for local assistance.
• Feed on demand, using positions that feel comfortable.
• Do not force the affected breast to empty by excessive pumping or the use of a silicone milk collector — fullness often comes from swelling, not milk.
• If exclusively pumping, express only the amount your baby needs.
• If pumping or hand expressing becomes painful or unproductive, rest the breast and use ice and lymphatic drainage to reduce swelling.

Your supply may dip temporarily but will recover after healing.

3. Use Breast Pumps Wisely

The updated mastitis protocol advises mothers to limit breast-pump use where possible. Over-pumping can overstimulate milk supply and worsen inflammation.
However, if your baby is in NICU or not latching, pumping remains essential. Ensure:

• You use a quality breast pump with the correct flange size.
• Avoid nipple shields unless absolutely necessary.

In my opinion one common reason for mastitis starting in the first place is the use of a breast pump that is not effective, thus stimulating without emptying.

Read more: How to Choose a Breast Pump

4. Apply Ice, Not Heat

Cold therapy reduces swelling, eases pain, and encourages better milk flow.

• Wrap ice packs or frozen vegetables in a cloth (never apply directly).
• Apply several times a day for 10–15 minutes.
• To stay warm, use a hot-water bottle on your lower back or tummy.

5. Supportive Underwear

Choose a soft, wire-free bra that supports your breasts without constriction. Swelling tends to collect at the base of the breast; a well-fitted bra prevents this, much like compression socks reduce ankle swelling.

6. Safe Medication and Natural Remedies

• Ibuprofen 800 mg every 8 hours for inflammation and pain
• Paracetamol 1000 mg every 8 hours for added relief (alternate every 4 hours)
• Arnica Gel (Natura) or Traumeel Gel (Heel) — safe homeopathic anti-inflammatory creams. Avoid contact with nipples.
• Natura Tissue salts 4, 9, and 12 — one of each hourly, then reduce to 3 times daily. You can purchase these separately or use our Mastitis Mix, which are made for us by Natura and contains the tissue salts and arnica.
• Sunflower lecithin — helps prevent milk fats from clumping, reducing risk of blocked ducts. Avoid if you are allergic to lecithin.
• Physiotherapy ultrasound — can help clear inflammation and pain. Ask at your hospital’s labour ward.

Note: Antibiotics are only necessary for confirmed bacterial mastitis.

7. Gentle Lymphatic Drainage — Avoid Deep Massage

Never use deep pressure or vibrating tools (like toothbrushes or massagers) on engorged breasts.
Instead:

• Use light skin strokes towards the lymph nodes under the arm and above the collarbone.
• Gentle compression during feeds is fine.
• Download this Lymphatic Massage Handout (PDF).

8. Protect Your Breast Microbiome

• Over-sterilising breast pump parts and over-cleaning overall can disrupt your body’s healthy bacteria. Follow the FDA’s breast pump cleaning guide: FDA Cleaning Breast Pumps
• Sterilise your pump once daily, but more often if your baby is premature or immunocompromised.
• Avoid unnecessary antibiotics.
• Only clean nipples if cracked or bleeding; rinse with mild salt water.
• Maintain a healthy diet and lifestyle to support your immune system.

Some research suggests probiotics like Limosilactobacillus fermentum and Ligilactobacillus salivarius may help — though products containing these are very limited in South Africa. Click here for a review of the rather controversial evidence on these probiotics.

9. Nipple Care and Nipple Bleb Management

A nipple bleb (a small white blister on the nipple) can be painful and linked to blocked ducts.

• Don’t over-clean or apply harsh ointments.
• Rinse with salt water if bleeding or cracked.
• Follow our Full Guide to Nipple Pain for more detail.

10. Understanding Oversupply

True oversupply is rare but can mimic engorgement or contribute to mastitis. Read La Leche League’s article for safe management tips: La Leche League on Oversupply. Avoid abrupt changes that might cause blocked ducts.

When Inflammatory Mastitis Becomes Bacterial Mastitis

You may have bacterial mastitis if you experience:

• Fever and rapid heart rate lasting over 24 hours
• Breast not improving despite home care
• Red, wedge-shaped swelling
• A painful lump or localised tenderness
• Pain or burning when feeding
• Breast feeling hot to the touch
• Ongoing flu-like symptoms

If these persist, see a doctor for antibiotics. In severe cases, hospital treatment may be necessary.

Outdated Mastitis Treatments to Avoid

Avoid the following — they can worsen inflammation or delay recovery:

• Hot compresses or warm showers
• Deep tissue massage
• Castor oil or saline soaks
• Excessive pumping or silicone milk collectors
• Vibrating devices or unusual feeding positions
• Cabbage leaves (risk of listeria; no proven benefit)

Should You Continue Breastfeeding During Mastitis?

Yes — keep breastfeeding unless your healthcare provider advises otherwise. Even if milk contains traces of blood or pus, it’s not harmful to your baby. Stopping abruptly can cause further engorgement and increase infection risk.

If your baby refuses the affected side (milk may taste salty during infection), express and discard that milk while continuing on the other side. Return baby to both breasts once symptoms settle.

Long-Term Effects and Recovery

Untreated mastitis or blocked ducts can lead to a breast abscess, a painful condition requiring medical intervention.

Mastitis can also affect milk supply temporarily. With consistent breastfeeding or expressing, your body will usually recover its normal production.
To prevent recurrence:

• Identify and address underlying causes.
• Continue taking sunflower lecithin if you’re prone to blocked ducts.

For further reading, visit: La Leche League – Mastitis Information.

Key Takeaway

With correct care, most moms recover fully from mastitis and continue successful breastfeeding. Early recognition, gentle treatment, and professional support are the best ways to prevent complications like blocked ducts, nipple blebs, engorgement, or breast abscesses.

If you suspect mastitis, seek advice from a qualified lactation consultant or healthcare provider experienced in mastitis treatment South Africa.