It may surprise you learn that the treatment of mastitis has changed really quite significantly.  No more heat or electric toothbrushes! (If you know, you know!). 

The Academy of Breastfeeding Medicine (ABM) Clinical Protocol #36 (2022) differs from the old one (revised March 2014) in several ways. The changes include the fact that plugged ducts are now thought to be narrowing of the ducts and not previously thought blocked ducts and the use of ice and anti-inflammatory treatments are now recommended instead of heat. Oversupply is now thought to be  the first marker on the mastitis spectrum and that probiotics instead of antibiotics may be more helpful in some cases. 

The new Protocol can be summarised as follows: 

1. Oversupply is the first marker on mastitis spectrum. Hyperlactation can lead to inflammation resulting in narrowing of milk ducts (previously called blocked ducts) and could lead to inflammatory mastitis. 

2. Plugged ducts are now thought to be ductal narrowing. 

3. Therefore ice and other inflammatory treatments should be used instead of heat (cold reduces blood flow and therefore swelling). 

4. No increased pumping to drain breast is recommended. 

5. Demand feed/pump as you have been (follow baby’s feeding cues) 

6. Stop dangle feeding/vibration with electric toothbrush etc because issue is not a blocked duct. 

7. Consider feeding from unaffected breast first before affected breast to avoid over stimulation. 

8. Use ice packs instead of heat and NSAIDS such as Ibuprofen. 

9. Gently massage sweeping up from nipple towards armpit to encourage lympathic drainage instead of deep tissue massage previously advised. 

10. Antibiotics reserved for bacterial mastitis. Should be avoided if possible as disrupts breast microbiome and therefore increases risk of progression to bacterial mastitis. 

11. Use probiotics instead of antibiotics to help microbiome. 

So there we go! Help to spread the word as old news still seems to be circulating.  

Reference:  Mitchell et al, Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022  Breastfeeding Medicine Available at: https://www.bfmed.org/protocol