Podcast Episode #248
How to Treat Mastitis, with Dr Nicole Gale
If you’re pregnant or have recently had a baby, this episode is a must-listen. Joined by Dr Nicole Gale, a GP and Lactation Consultant specialising in breastfeeding medicine, we dive deep into mastitis—what it is, how to treat it, and ways to prevent it.
In this episode, we cover:
- What exactly is mastitis? Recognising signs and symptoms early.
- Infective vs inflammatory mastitis: Understanding the difference.
- Treatment options and practical management tips including lymphatic massage, ice packs, ultrasound therapy, and medication.
- Red flags to watch out for, including inflammatory breast cancer and abscesses.
- Milk blebs: How to spot and effectively manage these painful white spots.
- Prevention strategies: Easy ways to avoid mastitis, especially in the early weeks of breastfeeding.
- Practical breastfeeding tips for pregnant women and new mums.
- Microbiome and probiotics: Could they help with recurrent mastitis?
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If you’re breastfeeding or planning to breastfeed, this is an important read. Mastitis can be painful, confusing, and downright exhausting—but the good news is, there’s help and hope. In this podcast episode, I sat down with Dr Nicole Gale, GP and breastfeeding specialist, to unpack how to treat mastitis, what to look out for, and how to prevent it in the first place. Whether you’re a new mum or expecting your first baby, understanding the early signs and having the right tools can make all the difference.
What is Mastitis?
Mastitis is an inflammation of the breast tissue that can occur during breastfeeding. It often involves pain, swelling, warmth, and redness in the breast and can sometimes be accompanied by fever or flu-like symptoms.
Mastitis doesn’t always mean infection—it may be caused by blocked milk ducts, engorgement, or inflammation from poor milk drainage. Understanding the root cause is key to effective treatment.
Mastitis Early Signs
Recognising the early signs of mastitis can help prevent complications. Look out for:
- Localised breast pain or tenderness
- A firm, sore lump
- Redness or warmth in one area of the breast
- Flu-like symptoms (fever, chills, fatigue)
- A sudden drop in milk supply from the affected breast
Dr Nicole Gale emphasises that acting early—before infection sets in—can make recovery quicker and less invasive.
Treatment of Mastitis
Wondering how to treat mastitis effectively? Here are the key steps:
- Keep breastfeeding or expressing from the affected side frequently
- Apply warmth before feeding to help milk flow (e.g., warm compress or shower)
- Use cold packs after feeding to reduce swelling
- Stay well hydrated and rest as much as possible
- Lymphatic massage before and after feeding (can be taught by your women’s health physio)
- Therapeutic ultrasound provided by your women’s health physio
- Pain relief: paracetamol or ibuprofen is usually safe while breastfeeding (check with your doctor)
If symptoms worsen or don’t improve within 24 hours, consult your GP. Antibiotics may be needed if bacterial infection is suspected.
Mastitis Prevention
You can reduce your risk of mastitis by:
- Ensuring a deep and effective latch during feeds
- Avoiding long stretches between feeds
- Rotating feeding positions to drain all parts of the breast
- Checking for tight bras or clothing that may compress the breast
- Responding to early signs of engorgement or blocked ducts promptly
Prevention is about supporting consistent milk flow and minimising inflammation.
Practical Tips for Mastitis
Dr Nicole Gale shared several helpful tips on the podcast:
- Don’t stop breastfeeding—milk removal is essential for healing
- Use gentle lymphatic massage towards the armpit rather than aggressive kneading
- If you’re too sore to breastfeed, express gently instead
- Rest is not a luxury—mastitis recovery requires downtime
- Seek help early—especially if this is your first experience with mastitis
Inflammatory Breast Conditions
Not all breast pain is mastitis. Other inflammatory conditions include:
- Engorgement: when breasts are overly full and swollen
- Blocked ducts: localised pain and a small lump that comes and goes
- Subacute mastitis: low-grade inflammation that doesn’t escalate into infection but still causes discomfort
Seeing a breastfeeding-informed health professional is crucial to getting the right diagnosis.
Mastitis – Abscess
If mastitis is left untreated or worsens, it can lead to a breast abscess—a pocket of pus that may require drainage. Symptoms include:
- A painful, swollen lump that doesn’t go away
- Fever or persistent inflammation
- A worsening sense of illness despite other treatment
This is a more serious complication and needs medical attention immediately.
Milk Blebs
Milk blebs (also known as nipple blisters or blocked nipple pores) can contribute to mastitis. They look like a white or yellow dot on the nipple and may be painful.
Treatment includes:
- Warm compresses
- Gentle exfoliation with a warm, wet cloth
- Sterile needle release (under medical guidance only)
If you notice a bleb, don’t ignore it—it can block milk flow and lead to inflammation.
Probiotics for Mastitis
Emerging research supports the use of probiotics in managing and preventing mastitis, particularly Lactobacillus fermentum and Lactobacillus salivarius. These strains may help:
- Restore healthy breast microbiome
- Reduce inflammation
- Lower recurrence of mastitis
Ask your healthcare provider about probiotic strains specific to mastitis support.
Reverse Pressure Softening
Reverse pressure softening is a technique used to soften the areola before latching when the breast is overly full or engorged. This can help the baby latch more effectively and improve milk drainage.
How to do it:
- Place clean fingers around the nipple and press inward gently for 60–90 seconds
- This helps shift swelling away from the nipple, making latching easier
This technique can be a game-changer in mastitis prevention and early treatment.
Breastfeeding Tips for Pregnant Women
If you’re still pregnant, it’s never too early to prepare. Here are some proactive tips:
- Learn about normal breastfeeding patterns and what to expect
- Understand how to recognise blocked ducts or signs of mastitis early
- Know who to call—have a list of lactation consultants or GPs who specialise in breastfeeding
- Stock up on nipple care products, breast pads, and a cold compress
- Practice hand expressing before baby arrives, if recommended by your care team
About Dr Nicole Gale
Dr Nicole Gale is a GP based in Australia with a special interest in breastfeeding medicine and women’s health. She brings a unique, evidence-based approach to supporting mothers through common (and not-so-common) breastfeeding challenges, including mastitis, nipple trauma, tongue ties, and supply issues.
Dr Gale is also a strong advocate for informed care and early intervention, helping women feel heard, supported, and empowered during the postpartum period.
** This podcast has general information only. Always seek the guidance of your doctor or other qualified health professional with any questions or concerns you may have regarding your health or medical condition.
Links
Free Birth Prep Session: https://www.fitnestmama.com/pregnancyworkshop
Preparing for birth Pelvic health checklist
Free 7 Day Trial Pregnancy Workouts
Free 7 Day Trial Postnatal Workouts
Instagram @kathbaquie.physio
