Mastitis Puerperalis (Breast Infection During Breastfeeding)

By | June 8, 2022

Puerperal mastitis is an inflammation of the milk-producing (lactating) breast that is caused by a bacterial infection and is the most common complication during breastfeeding, along with engorgement. About one in a hundred women is affected by mastitis puerperalis after childbirth, although the disease is usually easy to treat.

What is puerperal mastitis?

Mastitis puerperalis is an acute inflammation of the mammary glands during breastfeeding, which is due to bacterial pathogens (over 90% to Staphylococcus aureus). For ehh – esophageal hiatal hernia, please visit

Depending on the type of spread, a distinction is made between two forms of puerperal mastitis. In most cases, puerperal mastitis spreads diffusely in the connective tissue of the breast via the lymphatic system or the blood (interstitial puerperal mastitis).

In addition, puerperal mastitis can spread through the milk duct system of the affected breast, with transmission primarily occurring during breastfeeding.

Breast infection during breastfeeding is extremely painful and should be evaluated and treated by a doctor. A first relief can be achieved with cooling compresses.


Puerperal mastitis is triggered by contamination with a bacterial pathogen, which usually originates from the child’s nasopharynx, which is colonized by germs. The child may have been infected by the mother or by hospital staff (nosocomial infection).

In addition, contamination is possible as a result of contact between the breast skin and the lochia (wound secretion after birth) classified as infectious. The pathogens penetrate the breast via rhagades (fine cracks) in the nipple (mammilla), the areola or the skin during breastfeeding, spread and trigger puerperal mastitis.

In addition, puerperal mastitis can be caused by engorgement, in which the multiplication of the pathogens can also be promoted, similar to “standing water”.

Symptoms, Ailments & Signs

Symptoms of breast inflammation during breastfeeding can be varied. At the beginning, the inflammation will become noticeable through an increased feeling of tension in the entire breast. This tension will gradually develop into more severe pain. The breast will swell and be harder than normal. In addition, redness will be observed.

Because the breast is inflamed, it will feel hot. In connection with this, fever can appear “out of nowhere”. Furthermore, affected women often suffer from sweating and circulatory problems. Many feel sick and exhausted. The affected breast will also increase significantly in size. These symptoms usually only occur once during breastfeeding. However, in some cases, a relapse can occur.

In rare cases, mastitis leads to the formation of encapsulated accumulations of pus ( abscesses ). In the worst case, fistulas develop as a result. These fistulas allow pus to seep into surrounding tissue, under the skin, or even into organs. Touching the diseased breast is almost unbearable in this case.

Cooling compresses have a soothing effect. The symptoms described should have subsided after two weeks at the latest. If this is not the case, a doctor should be consulted.

Diagnosis & History

Puerperal mastitis is diagnosed during a clinical examination. A painful swelling in the area of ​​the affected mammary gland, together with reddening, overheating of the skin and sudden fever, body aches and swollen axillary lymph nodes are characteristic symptoms of puerperal mastitis.

The diagnosis is confirmed by a blood analysis, which tests the blood for inflammatory markers. In some cases (4-12%) of puerperal mastitis, an abscess (collection of pus) forms within 1 to 3 days. If abscess formation is suspected, sonography ( ultrasound examination ) is required to determine the size and location of the abscess.

In general, the course of puerperal mastitis is good and the inflammation resolves quickly either on its own or as a result of treatment. However, if puerperal mastitis was already present, the disease can become chronic and the risk of recurrent puerperal mastitis is increased.


A breast infection during breastfeeding is usually very uncomfortable and leads to burning pain and other restrictions. In order to avoid consequential damage, treatment by a doctor is therefore necessary in any case. Those affected suffer primarily from fever during breastfeeding. In addition to the fever, there is also fatigue and exhaustion.

The mother’s breasts become inflamed, causing pain and discomfort in the breast. This is particularly painful when breastfeeding. The breasts can also enlarge or swell due to the breast infection during breastfeeding. Furthermore, the usual symptoms of flu also occur, so that the patients suffer from headaches and body aches. The quality of life is significantly reduced by this disease.

In many cases, however, the breast infection during breastfeeding does not lead to further complications and disappears on its own. Treatment is rarely necessary. However, this is carried out with the help of antibiotics and does not lead to further complications. The life expectancy of the patient is also not affected by the breast infection during breastfeeding.

When should you go to the doctor?

Puerperal mastitis only occurs in women after childbirth and while breastfeeding. A doctor should be consulted if there is pain or changes in the appearance of the skin on the breast. Painkillers should only be taken in consultation with a doctor, as they can lead to complications for both the mother and the baby. Swelling of the breast or nipple should be evaluated by a doctor. If the mother refuses to breastfeed the infant because of the existing symptoms, a doctor should be consulted. It must be ensured that there are no impairments or shortages in the care of the newborn child.

A doctor is needed if the mother has a fever, is generally unwell or is sweating. If there are irregularities in the heart rhythm or a collapse of the circulatory system, it is advisable to have the symptoms clarified by a doctor. The formation of pus, lumps or fistulas in the breast must be examined and treated. If the mother suffers from anxiety, if she rejects her child or if other emotional irregularities occur, a doctor or therapist is needed. A reduced well-being, mood swings or behavioral problems should be presented to a doctor. These are signs of a health condition that needs to be investigated and treated.

Treatment & Therapy

In the case of puerperal mastitis, physical measures are used first. This includes cooling and consistent emptying of the breast to avoid engorgement. In addition, milk production can be reduced with prolactin inhibitors.

The affected breast should also be immobilized if possible. If there is no improvement within 24-48 hours, antibiotic therapy is recommended. Since about 80 percent of Staphylococcus aureus strains are resistant to penicillin, the doctor takes a smear test to determine an antibiotic to which the pathogen is not resistant. If an abscess has formed later on, the doctor can drain the abscess through an incision (minimal skin incision) by placing a strap or a small tube in the abscess cavity to drain the wound secretion (suction-irrigation drainage).

Daily wound irrigation is required until the puerperal mastitis has completely subsided. If only small subcutaneous abscesses develop as part of puerperal mastitis, these can possibly be punctured and the wound secretion suctioned out with the help of a syringe. While breastfeeding can continue after the first two days in the case of mild puerperal mastitis, breastfeeding should be avoided in any case in the case of abscess-forming puerperal mastitis.

Outlook & Forecast

The prognosis of breast inflammation during lactation is favorable. Spontaneous healing is often documented in many of those affected. Medical care should be provided to ensure that no subsequent disorders or long-term complications occur. Accompanied by a trained doctor, different approaches to alleviating the symptoms are pursued.

In a large number of cases, immobilization of the breast is sufficient to achieve an improvement in the overall situation. In addition, the breast should be cooled and breast milk should be completely evacuated. If there is no improvement within a few days, a regression of milk production is initiated by the administration of medicines. As soon as the organism stops producing milk after childbirth, the irritation can heal completely. Since the disease is caused by bacteria, drugs are administered that are aimed at killing the pathogens. They are then removed from the body and excreted.

If the course of the disease is favorable, you will be free of symptoms after a few days of rest. If an unfavorable course develops, recovery can be expected as soon as milk production has ended. A few days or weeks later, the inflammation has completely healed. If breast inflammation occurs again after another pregnancy, the prognosis is also good.


Adequate skin care of the breast to avoid rhagades (ointments, creams) can prevent mastitis puerperalis while breastfeeding. Regular and careful emptying of the breast can also contribute to prevention by reducing the risk of breast engorgement. In addition, direct contact of the breast with lochia should be avoided to avoid puerperal mastitis.


Puerperal mastitis can recur at any time after it has healed successfully, which is why it is important to check the flow of milk immediately afterwards. It is particularly important to ensure that the breast is emptied as much as possible. If the child has not drunk all of it, it can help to express the remaining milk to prevent it from building up again. Follow-up care is therefore more focused on preventing breast infection.

Once invading germs have settled in the accumulated breast milk and caused an infection, further complications can result. It is important to normalize the changed drinking behavior of the child as quickly as possible. If this does not seem feasible, a switch to bottle feeding must be used as an alternative so that the child does not suffer from dehydration and nutrient deficiencies.

You can do that yourself

In the case of mastitis puerperalis or breast inflammation during breastfeeding, the affected person can take some measures to relieve the symptoms and heal the inflammation.

First of all, a well-fitting bra is an advantage in the event of a breast infection. A warm compress can also be placed on the breast before each breastfeed. This stimulates the flow of milk due to the heat. During the time between breastfeeding, cooling the breast with ice packs or cottage cheese wraps may improve inflammation. Wraps with acetic alumina can also lead to cooling and thus to an improvement. The breast should be emptied regularly to avoid accumulation of milk in the breast. In addition, the person concerned should ensure that they drink enough fluids. Bed rest is also important.

If puerperal mastitis is too severe, the affected person is often unable to breastfeed because of the pain. A doctor should be consulted who will prescribe medication that cannot harm the infant. If there is no improvement in puerperal mastitis after using the self-help measures mentioned, a doctor should be consulted, who will then usually start treating the breast infection with antibiotics.

Mastitis Puerperalis (Breast Infection During Breastfeeding)