Physiotherapy & Mastitis

What are the key messages from the protocol?

A new mastitis protocol was published by the Academy of Breastfeeding Medicine (ABM), which replaced the previous ABM protocol from 2014



There is no plug of stuck milk in a duct that needs to be squeezed, massaged, or sucked out!


Mastitis originates from narrowed milk ducts and inflamed breast tissue


Mastitis is breast inflammation with or without infection present – primarily its inflammation


Milk stasis, diet, nipple trauma, or poor hygiene of pump parts are not considered a cause of mastitis (as previously thought)

Hyper-lactation/oversupply is thought to be a contributing factor and needs addressing 

Breast dysbiosis is a disruption to the ideal balance of good and bad bacteria in the breast i.e., the microbiome, and could be a contributing factor to mastitis


Use of breast pumps and nipple shields are discouraged generally due to their disruption of the milk microbiome (mother/baby direct contact is the ideal for microbiome health)


Saline soaks, castor oil, ointments applied to the nipple, or Epsom salts soaks in bulb shaped pumps, are not advised due to risk of nipple skin breakdown


Nipple blebs/white spots should not be squeezed, lanced, or the top lifted off with a needle, rather use of lecithin, working on positioning and attachment, and if needed a moderate potency steroid cream to the tip of the bleb to help break down the thickened tissue


Mastitis is advised to be treated initially with rest, continuing to feed on demand, paracetamol/ibuprofen, probiotics such as Lactobacillus plantarum (e.g., Qiara), lecithin 5-10g daily, and (with your physiotherapist) therapeutic ultrasound with very gentle lymphatic drainage style massage moving away from the nipple


Bacterial/infective mastitis is considered when initial approaches as above are not effective over a 24-hour period and the mother is very unwell with fever and flu like symptoms


It is safe for babies to feed off a breast with mastitis and if the mother is being treated with antibiotics

Ready to make an appointment?

Not quite? Carry on with the article below >

Who can help professionally? Sometimes you need a team:

  • Lactation consultants for help with babies latch and supply issues
  • women’s health physiotherapists for therapeutic ultrasound and lymphatic drainage
  • pharmacists and GPs for help with medication


At FNQ Health co at Yorkeys and Trinity Beach we have a physiotherapist trained to help.


We also have Qiara (Pregnancy & Breastfeeding) available to purchase. 


We consider mastitis urgent and aim to see mothers within 24 hours of inquiry. Phone 40795509 or book a mastitis appointment online https://fnqhealthco.com.au/book-online/



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