Is it okay to express breast milk with mastitis?

From the Guidelines

It is recommended to continue pumping or breastfeeding with mastitis, as regular emptying of the affected breast can help clear the milk ducts and prevent the condition from worsening. According to the American Academy of Pediatrics 1, mothers with mastitis are encouraged to continue to breastfeed, and regular feeding or expression of milk is an adjunct to other treatment. This approach can help reduce the risk of complications, such as breast abscesses, which require drainage.

To manage mastitis, it is suggested to:

• Continue to empty the affected breast regularly through nursing or pumping every 2-3 hours, even though it may be painful
• Apply warm compresses to the affected area before pumping to improve milk flow and reduce pain
• Take over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (650-1000mg every 6 hours) to manage discomfort and inflammation
• Rest as much as possible, increase fluid intake, and wear loose, comfortable clothing
• If symptoms don't improve within 12-24 hours, contact your healthcare provider as you may need antibiotics, typically a 10-14 day course, such as dicloxacillin, cephalexin, or clindamycin.

Breastfeeding can continue on the affected side as long as the infant’s mouth does not contact purulent material, and continuing to remove milk regularly is crucial for recovery as milk stasis (buildup) can worsen the infection and lead to abscess formation. The benefits of breastfeeding, including reduced risk of various diseases and conditions, such as type 2 diabetes mellitus [@102@], hypertension [@105@], and breast cancer [@106@], should also be considered when making decisions about breastfeeding with mastitis.

From the Research

Mastitis and Breast Pumping

• Mastitis is an inflammatory condition of the breast that can occur in breastfeeding women, with an incidence of approximately 10% in the United States 2, 3.
• The diagnosis of mastitis is usually clinical, based on symptoms such as fever, malaise, focal breast tenderness, and overlying skin erythema or hyperpigmentation 2, 3.
• Treatment of mastitis often involves conservative measures, including nonsteroidal anti-inflammatory drugs, ice application, and feeding the infant directly from the breast 2.
• Regarding breast pumping, the evidence suggests that frequent overfeeding and excessive pumping to empty the breast may worsen the condition 2.
• In fact, a 1- to 2-day trial of minimizing pumping is often recommended as part of the conservative treatment measures for mastitis 2.
• However, effective milk removal is an essential part of the treatment, and women with mastitis can usually continue to breastfeed from the affected breast during treatment 4.

Complications and Prevention

• Breast abscess is a common complication of mastitis, which can be prevented by early treatment of mastitis and continued breastfeeding 3, 5.
• The traditional management of breast abscesses involves incision and drainage of pus, but repeated needle aspirations and suction drainage have been reported as alternative treatments 5.
• Proper lactation technique, including a good infant latch, and encouraging physiologic breastfeeding rather than pumping, can help prevent mastitis 2.
• The use of probiotics for treatment or prevention of mastitis is not supported by good evidence 2.

Treatment and Breastfeeding

• Continued breastfeeding is generally recommended in the presence of mastitis, as it does not pose a risk to the infant and can help prevent complications such as breast abscess 3, 4.
• Antibiotics may be prescribed if there is no improvement in symptoms, with narrow-spectrum antibiotics preferred to cover common skin flora such as Staphylococcus and Streptococcus 2, 3.
• Many antibiotics are secreted in milk, but penicillin, cephalosporins, and erythromycin are considered safe for use during breastfeeding 5, 4.