Mastitis: Online Diagnosis and Treatment

Mastitis is a painful breast inflammation that can affect anyone but is more commonly associated with breastfeeding. Mastitis is an inflammation of breast tissue that may be accompanied by infection.

Lactational mastitis is the most common form of mastitis. It is estimated to affect between 2% and 25% of breastfeeding adults.¹ It most commonly occurs within 2 to 4 weeks after delivery. In one study, approximately 20% of breastfeeding women developed mastitis, with about one in every 10 having recurring episodes. Mastitis is most common in the first two months of breastfeeding.² The severity can range from needing treatment with oral antibiotics and minimal interference to breastfeeding to a severe infection requiring hospitalization for intravenous antibiotics.^3,4

Scheduling a consultation with a virtual doctor on the Telegra MD telehealth platform for mastitis diagnosis and treatment is simple and convenient. You will receive a diagnosis, a treatment protocol, and an appropriate online prescription to treat mastitis. Telehealth for mastitis treatment makes it easy to consult with a virtual doctor and receive prescription medication to treat your mastitis quickly and easily, even if you don’t have insurance. Schedule an appointment today to learn whether you might have mastitis and receive a personalized treatment plan to recover quickly.

What Is Mastitis?

Mastitis is inflammation of breast tissue that primarily occurs in lactating women and frequently leads to infection. Trauma to the nipple with breastfeeding may cause compression of more or more milk ducts. As milk sits in the breast tissue, it can become infected. Infected and inflamed breast tissue causes redness, pain, swelling, and fever.⁵

What Are The Common Symptoms Of Mastitis?

Mastitis is associated with the following symptoms:

• Breast pain, warmth, and tenderness
• Redness
• Breast swelling
• A palpable lump
• Fever
• Chills
• Muscle aches
• Nausea
• Vomiting
• Purulent nipple discharge
• Enlarged lymph nodes
• Extreme fatigue

Can Mastitis Be Treated Through Telehealth?

The primary goals for treating mastitis are to relieve symptoms, treat an infection, and maintain breastfeeding. Consulting a medical professional via telehealth is a convenient way to diagnose and treat mastitis. You can schedule an online medical consultation appointment with a virtual doctor using the Telegra MD platform and receive a personalized treatment plan. Your virtual doctor can give you tips on managing your mastitis symptoms and call your online prescription to a local pharmacy. Online doctors who prescribe mastitis treatment medications provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Why Do You Get Mastitis?

Currently, there is no consensus on what causes mastitis. According to the World Health Organization, mastitis is an inflammation of the breast that may or may not be accompanied by infection. Current theories are that it may be an inflammatory process, caused by an infection, due to a bacterial imbalance, or have a multitude of potential causes.

The two principal causes of mastitis are stagnated milk in breast tissue and infection. Milk stasis in the breast tissue may or may not progress to infection. An abscess, which is a walled-off infection In the breast, may also develop in more severe cases.

Changes in normal flora in the breast tissue may also contribute to mastitis. Changes in the maternal microbiome can be secondary to antibiotic use, probiotic use, use of breast pumps, or after having a Cesarean section.⁶

The most common bacterial infection that causes mastitis is Staphylococcus aureus. It is uncertain how bacteria enter the breast and cause infection since the mother and breastfeeding infant share the same flora.

Are Some People at Increased Risk for Mastitis?

Mastitis is more common in breastfeeding mothers but can occur in anyone. Factors that may increase mastitis risk include the following:^2,7,8

• Nipple cracking and damage
• Maternal stress and fatigue
• Poor maternal nutrition
• Milk stasis from one or more blocked milk ducts
• Wearing a tight-fitting bra
• Milk oversupply
• Infrequent feedings
• Using a manual breast pump
• Smoking history
• Infant cleft lip or palate
• Infant attachment difficulties
• Nipple piercing
• Plastic-backed breast pads

It is important to distinguish breast engorgement from mastitis. Engorgement is overfilling of breast tissue in both breasts. Increased pressure may cause breast tenderness and pain. Over time, breast milk production adapts to demand, and breast engorgement pain resolves.

How Do You Diagnose Mastitis?

Mastitis is a clinical diagnosis. The diagnosis is based on your medical history and physical exam. Mastitis severity varies from mild inflammation to severe disease.⁹

Questions your doctor may ask include:

1. What symptoms are you experiencing, and how long have they been present?
2. What have you tried to reduce breast pain and pressure?
3. Is your infant latching on and feeding well?
4. Have you noticed redness, swelling, pain, or tenderness in a specific region in your breast tissue?
5. Are you able to express breast milk from the affected breast?
6. Are you using a breast pump to express breast milk?
7. Have you had mastitis in the past?

How Do You Treat Mastitis?

In the first 12 to 24 hours, symptomatic therapy to improve milk flow from the breast is the ideal treatment.

Symptomatic care for mastitis may include:^8,9

• Cold or warm compresses to reduce swelling and inflammation
• Rest as needed
• Acetaminophen and ibuprofen as directed to reduce pain and inflammation
• Massage the affected breast
• Increase fluid consumption
• Continue breastfeeding, starting with the affected side
• Avoid wearing tight-fitting clothes or bras
• Apply expressed breast milk or lanolin to chapped nipples

If symptoms persist after 12 to 24 hours or worsen, antibiotics may be prescribed if an infection is suspected. The most common bacterial cause of mastitis is Staphylococcus aureus. If Staphylococcus aureus is resistant to methicillin, it is called methicillin-resistant Staphylococcus aureus or MRSA. Having an MRSA infection somewhat limits antibiotic choice.

Outpatient treatment:¹⁰

• Amoxicillin-clavulanate
• Dicloxacillin
• Flucloxacillin
• Cephalexin
• Clarithromycin

Methicillin-resistant Staphylococcus aureus (MRSA) suspected:¹⁰

• Clindamycin
• Trimethoprim-sulfamethoxazole
• Doxycycline
• Ciprofloxacin

Yeast infections can cause nipple cracking and milk stasis. Shooting pain out of proportion to the amount of redness may indicate a yeast infection. These infections are treated with antifungal medications.⁸

Fungal mastitis:^8,9,10

• Nystatin topical
• Miconazole typical
• Ketoconazole topical
• Fluconazole: not FDA-approved for mastitis but is commonly prescribed for more severe cases

In about 10% of cases, women who are treated for bacterial infection-causing mastitis will develop an abscess. This is a collection of infected fluid that is walled off and not as accessible by antibiotics. An ultrasound study can be used to diagnose an abscess. Symptoms of an abscess include a high fever, redness, tenderness, and skin thickening.

When Should You See a Doctor for Mastitis?

Mastitis associated with breastfeeding is common. When it is untreated or inadequately treated, it can lead to discontinuation of breastfeeding.¹⁰ To treat mastitis, continuing to express breast milk is key. It is not harmful to your infant for you to continue breastfeeding. The same bacteria colonize the parent and baby. Some infants may notice a taste change in breast milk from the affected breast. If necessary, express and discard this milk, but continue breastfeeding from the other breast.⁸

Telehealth for early mastitic treatment is the perfect option. You can schedule an online appointment with a virtual doctor using the Telegra MD platform and receive a diagnosis from your home. Your virtual doctor can give you tips on improving milk flow and relieving pain and call in a prescription to a local pharmacy. Online doctors who treat mastitis provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Obtaining a mastitis treatment plan after seeing a doctor online through telemedicine is similar to seeing your local doctor. In both cases, you would:

• Make an appointment: Typically, appointments to see virtual doctors through telehealth are much easier to make and are more convenient than in-person appointments, as many telemedicine companies provide online telehealth services for mastitis treatment at any time, day or night.
• Provide a medical history: Whether completing forms in your local doctor’s office or online before consulting with your virtual doctor, you will need to provide a medical history.
• Consult with your doctor: After reviewing your medical history forms, your virtual doctor will discuss your mastitis treatment options.
• Treatment: After deciding on an optimal and personalized treatment plan for mastitis, your virtual doctor will transmit your prescriptions to your local pharmacy.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Dixon, JM. Lactational mastitis. UpToDate. 2023. Lactational mastitis – UpToDate

2. Cullinane M, Amir LH, Donath SM, Garland SM, Tabrizi SN, Payne MS, Bennett CM. Determinants of mastitis in women in the CASTLE study: a cohort study. BMC Fam Pract. 2015 Dec 16;16:181. doi: 10.1186/s12875-015-0396-5. PMID: 26674724; PMCID: PMC4681172.

3. Feijen-de Jong EI, Baarveld F, Jansen DE, Ursum J, Reijneveld SA, Schellevis FG. Do pregnant women contact their general practitioner? A register-based comparison of healthcare utilisation of pregnant and non-pregnant women in general practice. BMC Fam Pract. 2013;14:10. doi: 10.1186/1471-2296-14-10. 

4.  Amir LH, The Academy of Breastfeeding Medicine Protocol Committee ABM Clinical Protocol # 4: Mastitis, Revision, March 2014. Breastfeed Med. 2014;9(5):239–43. doi: 10.1089/bfm.2014.9984.

5. Baeza, C. (2016). Acute, subclinical, and subacute mastitis. Clinical Lactation, 7(1), 7-10.

6. Mitchell KB, Johnson HM, Rodríguez JM, Eglash A, Scherzinger C, Zakarija-Grkovic I, Cash KW, Berens P, Miller B; Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med. 2022 May;17(5):360-376. doi: 10.1089/bfm.2022.29207.kbm. Erratum in: Breastfeed Med. 2022 Nov;17(11):977-978. PMID: 35576513.

7. Foxman B, D’Arcy H, Gillespie B, Bobo JK, Schwartz K. Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 2002 Jan 15;155(2):103-14. doi: 10.1093/aje/155.2.103. PMID: 11790672.

8. Spencer JP. Management of mastitis in breastfeeding women. Am Fam Physician. 2008 Sep 15;78(6):727-31. PMID: 18819238.

9. Wilson E, Woodd SL, Benova L. Incidence of and Risk Factors for Lactational Mastitis: A Systematic Review. Journal of Human Lactation. 2020;36(4):673-686. doi:10.1177/0890334420907898

10. Miller AC. Mastitis empiric therapy. Medscape. 2019. https://emedicine.medscape.com/article/2028354-overview