[Skip to Content]

Claim CME

Breastfeeding

Risk Factors, Symptoms, and Treatment of Lactational Mastitis

To identify the key insights or developments described in this article

1 Credit CME

JAMA

Published Online: January 26, 2023

JAMA Insights

Article Information and Disclosures

Adetola F. Louis-Jacques, MD¹;

Margarita Berwick, MD¹;

Katrina B. Mitchell, MD²

Author Affiliations

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville
²Breast Surgery Program, Ridley Tree Cancer Center, Santa Barbara, California

Read article on JAMA Network

Read Article Claim CME

Lactational mastitis affects approximately 2% to 20% of people who are breastfeeding¹ and is defined by inflammation of the mammary gland. Symptoms and findings include pain, erythema, induration, and swelling. Improved understanding of the physiology of lactation has led to recent changes in the guidelines for management of lactational mastitis² that emphasize conservative methods to improve symptoms and reduce unnecessary antibiotic use. This clinical insight summarizes current evidence regarding diagnosis and management of lactational mastitis. Breastfeeding is associated with improved health outcomes for parents and their children.³ Physicians can play a central role in appropriately managing complications such as lactational mastitis and supporting patients in continuation of breastfeeding.

Claim CME

Sign in to take quiz and track your certificates

Buy This Activity

Article Information

Corresponding Author: Adetola F. Louis-Jacques, MD, University of Florida, 1600 SW Archer Rd, PO Box 100294, Gainesville, FL 32610 (louisjacquesa@ufl.edu).

Published Online: January 26, 2023. doi:10.1001/jama.2023.0004

Conflict of Interest Disclosures: Dr Louis-Jacques reported receiving grants from Merck for Mothers Safer Childbirth Cities and grants from Robert A. Winn Career Development Award outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank Victoria Evans, MA (Clinical Research Coordinator at Pediatric Research Hub, University of Florida), for her editorial contributions.

References

Wilson E , Woodd SL , Benova L . Incidence of and risk factors for lactational mastitis: a systematic review. J Hum Lact. 2020;36(4):673-686. doi:10.1177/0890334420907898 PubMed Google Scholar Crossref

Mitchell KB , Johnson HM , Rodríguez JM , et al; Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine clinical protocol #36: the mastitis spectrum, revised 2022. Breastfeed Med. 2022;17(5):360-376. doi:10.1089/bfm.2022.29207.kbm PubMed Google Scholar Crossref

Louis-Jacques AF , Stuebe AM . Enabling breastfeeding to support lifelong health for mother and child. Obstet Gynecol Clin North Am. 2020;47(3):363-381. doi:10.1016/j.ogc.2020.04.001 PubMed Google Scholar Crossref

Fernández L , Pannaraj PS , Rautava S , Rodríguez JM . The microbiota of the human mammary ecosystem. Front Cell Infect Microbiol. 2020;10:586667. doi:10.3389/fcimb.2020.586667 PubMed Google Scholar Crossref

Sharp JA , Lefèvre C , Nicholas KR . Lack of functional alpha-lactalbumin prevents involution in Cape fur seals and identifies the protein as an apoptotic milk factor in mammary gland involution. BMC Biol. 2008;6(1):48. doi:10.1186/1741-7007-6-48 PubMed Google Scholar Crossref

Foxman B , D’Arcy H , Gillespie B , Bobo JK , Schwartz K . Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 2002;155(2):103-114. doi:10.1093/aje/155.2.103 PubMed Google Scholar Crossref

Jahanfar S , Ng CJ , Teng CL . Antibiotics for mastitis in breastfeeding women. Cochrane Database Syst Rev. 2013;(2):CD005458. doi:10.1002/14651858.CD005458.pub3 PubMed Google Scholar Crossref

Anderson L , Kynoch K , Kildea S , Lee N . Effectiveness of breast massage for the treatment of women with breastfeeding problems: a systematic review. JBI Database System Rev Implement Rep. 2019;17(8):1668-1694. doi:10.11124/JBISRIR-2017-003932 PubMed Google Scholar Crossref

Pileri P , Sartani A , Mazzocco MI , et al. Management of breast abscess during breastfeeding. Int J Environ Res Public Health. 2022;19(9):5762. doi:10.3390/ijerph19095762 PubMed Google Scholar Crossref

Johnson HM , Mitchell KB . Low incidence of milk fistula with continued breastfeeding following radiologic and surgical interventions on the lactating breast. Breast Dis. 2021;40(3):183-189. doi:10.3233/BD-201000 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.