Mastitis (radang payudara) is when part of the breast becomes swollen, hot and painful, often with a hard lump and flu-like symptoms; it is most common in breastfeeding mothers and usually affects one breast. Most cases get better with home care: keep breastfeeding on demand, use ice or a cold compress, and take paracetamol or ibuprofen. Current guidance from the Academy of Breastfeeding Medicine advises against deep massage and against pumping extra milk to “empty” the breast, as both can make inflammation worse. See a doctor if you are not better within 12 to 24 hours, as you may need antibiotics.
Apa itu mastitis? (mastitis maksud)
According to the NHS, mastitis is when your breast becomes swollen, hot and painful. It is most common in breastfeeding women and does not usually need medical treatment. It usually affects only one breast, and symptoms often come on quickly.
The Academy of Breastfeeding Medicine (ABM) now describes mastitis as a spectrum of conditions caused by inflammation in the milk ducts and swelling of the surrounding breast tissue, ranging from mild narrowing of the ducts to infection and, rarely, an abscess.
Tanda mastitis
According to the NHS, symptoms of mastitis include:
- a swollen area on the breast that feels hot and painful to touch; it may look red, though this can be harder to see on darker skin;
- a wedge-shaped lump or a hard area in the breast;
- a burning pain, which may be constant or only when breastfeeding;
- nipple discharge, which may be white or contain streaks of blood;
- flu-like symptoms, such as aches, a high temperature or feeling hot, cold or shivery, and tiredness.
The ABM notes that breastfeeding breasts can normally feel lumpy and full, and that hot flushes and sweating after birth can feel like a fever. Pain and redness after a long stretch of sleep is often swelling and inflammation rather than infection.
From engorgement to abscess: the mastitis spectrum
The ABM’s 2022 protocol describes several related conditions:
| Condition | What it means (ABM) |
|---|---|
| Engorgement | Very full, swollen breasts in the early days, usually 3 to 5 days after birth; if managed well, it should not progress further |
| Ductal narrowing (often called a “blocked duct”) | A tender, firm area from inflammation narrowing the ducts, without fever or feeling unwell |
| Inflammatory mastitis | Inflammation causing redness, pain and sometimes fever, without infection |
| Bacterial mastitis | Inflammation that has progressed to infection and may need antibiotics |
| Phlegmon | A firm, mass-like area of inflamed tissue, which can follow deep massage |
| Abscess | A collection of pus that needs draining; develops in about 3% to 11% of women with acute mastitis |
Punca mastitis
The NHS says mastitis is common in breastfeeding women because it can be caused by a build-up of milk. The ABM explains that it is more complex: making more milk than the baby needs, often from frequent pumping or overfeeding from one side, can worsen swelling and inflammation. It also links mastitis to changes in the breast’s natural bacteria, which can be affected by antibiotics, regular use of breast pumps and caesarean births. It also notes there is no evidence that specific foods cause mastitis.
According to the NHS, mastitis is also more likely to keep coming back if there are problems with positioning and attachment during breastfeeding.
Cara rawat mastitis di rumah
Combining NHS and ABM advice, most mastitis can be eased at home:
| Do | Avoid |
|---|---|
| Keep breastfeeding when your baby wants, for as long as they want | Pumping or feeding extra to “empty” the breast; the ABM says this keeps milk production high and worsens swelling |
| Make sure your baby is positioned and attached well; ask a nurse, midwife or lactation counsellor to watch a feed | Deep or forceful massage, electric toothbrushes or vibrating devices on the breast |
| Apply ice or a cold compress (for example, a cloth soaked in cold water) for about 10 minutes every hour | Firm pressure on the breast; any pressure should be gentle (NHS) |
| Take paracetamol or ibuprofen for pain or fever | Aspirin (NHS) |
| Hand express only enough for comfort if your breast is too full or painful to feed | Oils, soaks or creams on the breast (NHS); saline soaks and castor oil (ABM) |
| Wear a comfortable, well-fitting bra or loose top, and rest | Tight clothing or bras until you feel better (NHS) |
If the affected breast is so swollen that no milk comes out, the ABM says you can feed from the other breast for a while and return to the affected side as the swelling settles. Milk supply may dip temporarily but can be built up again. For practical tips on expressing and storing milk, see our guide to susu ibu.
Can I keep breastfeeding?
Yes. The NHS advises continuing to breastfeed. According to the ABM:
- it is safe for your baby to drink milk from a breast with bacterial mastitis;
- bacterial mastitis is not contagious and does not need a break from breastfeeding;
- there is no evidence that poor hygiene causes mastitis.
If you need antibiotics, the NHS says a very small amount may pass into breast milk. There is no risk to your baby, although it may make them a little unsettled.
Massage, heat, cabbage and “blocked ducts”: what the evidence says
Some common advice is not supported by current evidence:
- Deep massage to “clear the blockage”: the ABM advises avoiding deep massage, as it increases inflammation, swelling and tissue injury and may lead to a phlegmon. If you want to use touch, use only very light, sweeping strokes over the skin towards the armpit, similar to lymphatic drainage. This also applies to traditional urut on a sore breast.
- A single “milk plug”: the ABM explains that breast ducts are numerous and interlinked, and a firm area is usually inflammation and swelling, not one blocked duct.
- Hot compresses: heat widens blood vessels and may make swelling worse, although some mothers find it comforting. Ice is preferred for swelling.
- Cabbage leaves: studies have not found them more effective than ice, and the ABM notes cabbage may carry Listeria bacteria.
- Nipple shields: the ABM says the evidence does not support using them for mastitis.
When antibiotics are needed
According to the NHS, see a doctor if your symptoms do not get better 12 to 24 hours after treating mastitis at home. A doctor will usually prescribe antibiotics if it is not improving. See your doctor again if you are not better 48 hours after starting antibiotics.
The ABM advises that if there is no improvement after 48 hours of first-line treatment, a breast milk culture should be considered to look for resistant bacteria such as MRSA. This matters in Malaysia: in a study of breast abscess samples at Universiti Malaya Medical Centre, about 1 in 5 (19.5%) contained multidrug-resistant bacteria, and these were linked to a higher chance of needing surgical drainage. Take antibiotics exactly as prescribed, and go back to your doctor if you are not improving.
Breast abscess
A breast abscess is a collection of pus that needs draining. According to the ABM, it develops in about 3% to 11% of women with acute mastitis, and usually shows as a firm, red area that keeps getting worse, often with a lump that feels like it contains fluid. An ultrasound scan can confirm it.
According to the ABM, an abscess needs to be drained, often with a needle or a small drain, and fluid is usually sent for testing to choose the right antibiotic. Ask your doctor about continuing to breastfeed during treatment.
How to lower your risk
- Get help early with positioning and attachment; the NHS says repeated mastitis may be due to attachment problems.
- Feed on demand, and avoid pumping more milk than your baby needs, unless you are separated from your baby (ABM).
- If you use a pump, check the flange size and avoid very high suction or very long sessions, which can damage the breast and nipple (ABM).
- Avoid tight bras and clothing that press on the breast.
- Rest, eat well and accept help; the ABM highlights reducing stress and resting as part of care. See our guide to berpantang for recovery after birth.
When to see a doctor
According to the NHS, see a doctor if:
- your symptoms do not get better 12 to 24 hours after treating mastitis at home;
- your symptoms do not get better 48 hours after starting antibiotics;
- you get mastitis and you are not breastfeeding.
Get urgent medical help if you feel very unwell, as the ABM notes that severe infection may need hospital treatment. Any breast lump that does not go away after the mastitis settles should be checked; see our guide to kanser payudara.
Frequently asked questions (FAQ)
Apa maksud mastitis (what is mastitis)?
Mastitis is when part of the breast becomes swollen, hot and painful. According to the NHS, it is most common in breastfeeding women, usually affects one breast, and often does not need medical treatment. It can cause a hard or wedge-shaped lump, burning pain and flu-like symptoms such as aches, a high temperature and tiredness.
What are the tanda mastitis (signs of mastitis)?
According to the NHS, signs include a swollen area of the breast that feels hot and painful to touch and may look red (harder to see on darker skin), a wedge-shaped lump or hard area, burning pain that may be constant or only when breastfeeding, and sometimes nipple discharge. You may also feel achy, hot or shivery and tired, like having flu.
Can I continue breastfeeding with mastitis?
Yes. The NHS advises continuing to breastfeed whenever your baby wants. The Academy of Breastfeeding Medicine says it is safe for babies to drink milk from a breast with bacterial mastitis, and that mastitis is not contagious. If feeding from the affected side is too painful, hand express just enough for comfort and feed from the other breast.
What is the best way to treat mastitis at home?
Keep breastfeeding on demand, check your baby's position and attachment, apply a cold compress or ice to the sore area, and take paracetamol or ibuprofen for pain and fever, as advised by the NHS and the Academy of Breastfeeding Medicine. Avoid deep or forceful massage, avoid pumping extra milk to empty the breast, wear a comfortable bra, and rest as much as you can.
Should I massage the lump or use a hot compress?
Avoid deep massage. The Academy of Breastfeeding Medicine warns that deep massage can increase inflammation, swelling and tissue injury, and recommends only very light, sweeping strokes towards the armpit (lymphatic drainage). Ice or cold compresses reduce swelling; heat may feel comforting for some mothers but can make swelling worse.
When do I need antibiotics for mastitis?
According to the NHS, see a doctor if your symptoms do not get better 12 to 24 hours after treating mastitis at home. A doctor will usually prescribe antibiotics if it is not improving. See a doctor again if you are not better 48 hours after starting antibiotics, as a milk culture may be needed to check for resistant bacteria.
Can I get mastitis if I am not breastfeeding?
Yes. The NHS says women who are not breastfeeding, and men, can also get mastitis. Causes include smoking, damage to the nipple such as a piercing or eczema, breast implants, a weakened immune system from conditions like diabetes, and shaving or plucking hairs around the nipple. If you get mastitis and are not breastfeeding, see a doctor.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor, nurse or lactation counsellor. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Mastitis — NHS
- Mitchell KB, et al. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med. 2022;17(5):360-376
- Lee CJ, et al. Breaking the barrier: a study on multi-drug resistance in breast abscess at an academic Malaysian hospital. World J Surg. 2023;47(11):2743-2752
- Expressing and storing breast milk — NHS
