The New Mastitis Playbook: What Changed in 2022 and What You Should Do
If you’ve ever had breast pain, redness, swelling, or felt “off” while breastfeeding, you’ve probably heard the word mastitis. But the game-changer is this: the Academy of Breastfeeding Medicine (ABM) in 2022 redefined mastitis not as one single problem, but as a spectrum of conditions—from ductal narrowing and inflammatory changes to full bacterial infection and abscess. In this post, we’ll break down what the spectrum means for you, update your home-care toolbox, and highlight when you need medical intervention.
Understanding the “mastitis spectrum”
Previously, many felt the moment they had breast pain or a “plug,” the assumption was bacterial infection needing antibiotics. The 2022 ABM Protocol #36 clarifies that the pathway often starts with ductal narrowing or inflammation due to oversupply, stagnant milk flow, or tissue edema. If unchecked, these changes may progress to bacterial mastitis and then to abscess. Recognizing earlier stages means more targeted, less aggressive interventions.
First-line home care for inflammatory mastitis
If you’re seeing early signs (localized tenderness, heat, swelling, but no fever/systemic illness yet), try this:
Continue feeding or pumping on demand—avoid strict “emptying” marathons. Oversuction may worsen edema.
Use cold or ice packs over warm compresses. The new ABM guidance found that heat can worsen inflammation.
Gentle lymphatic massage: sweep lightly from nipple toward axilla (not deep pressure). The protocol calls aggressive massage “trauma-promoting.”
Evaluate latch, positioning, pump flange fit, and schedule. Address mechanical or flow issues.
Rest, hydration, and NSAIDs (if appropriate) help control the inflammatory reaction.
When antibiotics and further care are needed
If you develop:
Fever >38.5 °C (101.3 °F), chills, malaise
Worsening redness/swelling or rapidly expanding red area
No improvement after 12-24 hours of good home care
A palpable mass that persists or increases
Then you likely have progressed into bacterial mastitis (or even an abscess) and should seek medical evaluation. ABM recommends first-line antibiotics (e.g., dicloxacillin, cephalexin) in many cases.
Also, if there’s any concern for inflammatory breast cancer, stopping breastfeeding, or unusual features, refer promptly.
Prevention: what you can do now
Preventive strategies aim to keep milk flow smooth, avoid oversupply/engorgement, and maintain comfort.
Prioritize good latch & effective feeding/pumping to avoid stagnation or “too much” with poor removal.
Use appropriate pump flange size and avoid excessive suction or frequency.
Monitor for early signs: tightness, hardness, discomfort—not just isolated so-called “plugged ducts.”
Establish rest and self-care routines; stress and fatigue can contribute to inflammation.
Build a supportive environment: partner, community, and lactation consultant access.
Myths & FAQs
Myth: “I must always heat a plugged duct/wedge of redness.”
Truth: For most cases under the spectrum of mastitis, cold + gentle feeding + fix the cause works better. Heat may worsen swelling.
Question: “Should I stop breastfeeding if I have mastitis?”
Not usually—continuing on the affected side (as tolerated) is part of care unless your provider advises otherwise.
Question: “Does a ‘plug’ always mean infection?”
No—many plugs are actually early ductal inflammation/edema. ABM clarifies that the progression is not linear but a spectrum.
If you’re experiencing breast pain, swelling, redness, or signs of blocked ducts—or you’ve had recurring issues—schedule an urgent lactation assessment today. We’ll evaluate latch, pump fit, drainage, and develop your individualized prevention and care plan.
The information provided in this blog is for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Reading this content does not establish a patient–provider or professional relationship between you and Thrive Lactation Center or Sarah Schooler, RN, BSN, IBCLC.
Always seek the advice of your physician, pediatrician, or qualified healthcare provider regarding any questions you may have about a medical condition, breastfeeding, or your health. Never disregard or delay seeking professional advice because of something you have read here.