Expert: Sue Ennis - 7/20/2007

Question
Hi,
I am a new mom who had 2 boughts of mastitis in the first month of motherhood. I gave birth on the 12th of May. I was on heavy duty antibiotics for over 20 days in her first month and at about 5 weeks I finally made the painful decision to wean. I did this slowly over the course of almost a month by slowly lengthening out the intervals between pumping. By this past Monday I was only pumping every 12 hours. My breasts only produced half an ounce the last time I pumped (Monday evening).
Then I decided that I should finally just stop altogether. Since then I have had soreness and some spots of thickening, and I am hoping they will absorb over time, but as you can imagine I am terrified they will turn into mastitis again. My stomach is still in recovery from the antibiotics and ibuprofen so I really can't imagine having to take either of them again. My nipples and areolas are finally starting to look normal again although the skin is pink and it used to be brown, and I do have some sharp pains from time to time. My breasts are very fibristic which I imagine might have contributed to my problems. I have been told to heat, to express a little by hand when there is pressure, to just ice and not heat-- the advice runs the gamut. And my milk comes in all the time, it seems it comes in every 2 hours even though I have worked on this for so long. And it hurts when it comes in too. What a crazy ride. I don't really leak even though it lets down a lot, which may just be because it isn't much (I hope).
My question is, will this dissipate with time, if I am okay to not pump, and should I be heating the thick areas or icing them? What should I expect and what should I do? I am so scared and I just want to do what's best for my breasts and get past this so I can focus all of my energy on my new baby. I don't really feel overall pressure, just soreness especially in the areas of thickness. But, these areas are not red and I don't have a fever.
Thank you so much for any advise you can offer, I really have searched long and hard for someone with your expertise.

Answer
Hello Heather - since you have gone through two rounds of mastitis already, you know what you are dealing with.  

And typically, multiple cases occur because your body just does not get the chance to fully fight off the first infection, and with the stress and fatigue of fighting it along with the schedule of being a new mother ... it's all too easy for the infection to set in again, just as you start to feel better from clearing up the first infection.

At this point, you mention being told either to use cold or to use warmth on your breasts...allow me to give you a third, and this takes both sides :)  Seriously, you can try alternating between the two temperatures for two different reasons to combat on both end and to soothe and to promote infection fighting.

My recommendation is a bit of a timing juggle. But the routine in a nutshell is warm packs -- breastfeed/pump --cool packs.  To easily apply two temperatures, you can use the LaMa Bra and either chill or warm the gel packs before putting them into the bra cup pockets....you can order extra gel packs for this purpose too, see www.lamabra.com.  You chill the cold packs in the freezer and to warm the gel packs you can immerse the them into hot water for a minute.  

Then you'll want to try the following:

Use warmth against breasts to: (before you pump .. or for other if you breastfeed)_
-increase circulation which will help get the infection fighting antibodies into more action
-promote the let-down effect - ie. increasing the milk release reflex (you in particular are at the end of the weaning, so this will help move the last stages along for you

Since your first onset was early months while fully nursing, you know that breastfeeding through this is really best to work through it...

But with weaning, you can express what you have left as you are doing then after your breast milk is pumped:

Apply coldness to the breasts to:
-relieve pain and soothe the nipple area (or engorgement for others)
-constrict the ducts to further slow the breast milk production

In your particular case you mention that the red and heat is gone, so it appears you are getting past the peak of mastitis. But please keep a careful eye on your breasts and be sure to check with your doctor should each day not be better than the prior.  You may need to get another prescription to stop the infection from coming back or to combat the build up with can lead to abscess...

Mastitis is a tough one as many symptoms are like the flu and are let run longer than they should.  So do keep in contact with your doctor to make sure this infection of your breast tissue only becomes better each day.

You and your body can do amazing things! So most importantly take care of yourself. Rest and relaxation is one of the best things to boost your immunity...and be sure to be eating nutritionally for an added kick.  And before long that energy will spike :)

Do hope this is helpful!
All the best.