Dedicated to the care of breast cancer and all breast conditions
Dr Sarah Rayne is no longer practising in
Johannesburg and this practice is closed.

These pages are for information only,
and current only until 2018
I’ve just been diagnosed with breast cancer- help!
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I’ve noticed a lump in my breast
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I have breast pain               
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I need advice about breastfeeding
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Breastfeeding infections  
With the precious gift of motherhood a woman is given a second gift, in the ability to nurture and sustain her new child through breastfeeding. Breastfeeding is a wonderful source of infant nutrition and immune system support and helps mothers and babies bond. But sometimes it is not all easy or uncomplicated

What is mastitis?
I think I might have a breast infection
If I have got mastitis what should I do?
I might have a breast abscess
I might have Thrush in the breast
Breast infections (known as ‘mastitis’) occur in approximately 10% of breastfeeding women and can be distressing and miserable at a time where the new motherhood is already exhausting and emotional: for a first-time mom or even for an experienced mother. It can interfere with bonding and can discourage breastfeeding completely, with all its health benefits for baby and mother.

Infections most often occur within the first three months of breast-feeding, with a second increase around weaning. If you are have diabetes, smoke or have other risk factors you can be at particular risk.It is commonly caused by bacteria present normally on the skin but which enter the breast and cause an infection.

  • Difficulties with latching
  • Infant mouth problems
  • First-time mother
  • Cracked or sore nipples
  • Previous mastitis
  • Yeast infection
  • Blocked ducts or missed feeds
  • Plastic-backed breast pads
  • Use of a manual breast pump
  • Nipple piercing
  • Tight-fitting bra
I think I have a breast infection
An infection causes a part of the breast to become hard, red, painful and swollen in size. Generally you may find you have a fever, feel unwell and tired with flu-type aching.

Not all breast pain is an infection however. A blocked duct can also cause the breast to be painful and red but these will clear in 1-2 days. Massage to ensure emptying of that area, and simple measure such as hot/cold compresses and simple painkillers can help. If your symptoms don’t get better after 2 days there is a risk of an infection and you should see your doctor or come for help.

The best way to prevent infections is teamwork- get you and your baby breastfeeding really well. All babies know how to suck, but they are not born knowing how to breastfeed and neither is a mom. Breastfeeding needs practice and support. It can require perseverance and patience! Don’t wait until you are exhausted and anxious, try to get help early from a lactation consultant, specialist midwife or breastfeeding support network.

Baby should latch with a wide-open mouth, and it may help to change baby’s position through the feed to drain all areas of the breast. Tight bras and some breast pads can cause your nipple to be moist after a feed rather than allowing the nipples to air.
If I have got mastitis what should I do?
Mastitis is usually treated with antibiotics which can get rid of the bacteria. Simple pain medications that are safe to use in breast feeding can also be taken. Warm showers or cold packs will also help with the pain, along with rest, sleep and plenty of fluids.

I always used to find it infuriating that people tell you to rest and sleep to help with breastfeeding when I didn’t have time to sleep with all the breastfeeding I was doing! But these things do help, and this is the time to enlist family and friends to take the baby to settle after a feed and let you get that rest.

Dealing with an infection is teamwork- you, baby and your doctor. Your baby can play a key role removing milk from your breast by continuing to feed, as milk not removed from the breast can cause the infection to worsen. You might be concerned your milk will contain pus and will be bad for your baby but feeding from an infected breast will not harm your baby. Even if bacteria are present in the milk, the acid in your baby’s stomach will kill them. You can continue to breast feed but sometimes your baby will not like the taste of the milk. In this circumstance you can express the milk (and therefore maintain production) but continue to feed from the other side.

Studies have found that the use of antibiotics is twice as quick at fighting infection. Your doctor will choose an antibiotic that is safe to give in breastfeeding and has the most up to date ability to kill the bacteria. The course should continue for at least 7 days but may need longer.
I might have a breast abscess
Very occasionally the infection will progress and an abscess will form. This is your body’s way of separating the infection into an isolated collection of pus. This will cause a firm, very painful lump. An abscess can be seen on sonar, which is why it is often good to get specialist help early- to prevent this from happening and act promptly if it does.

Breast abscesses should be managed by a breast specialist, and very rarely need surgery. In the past, women would undergo operation for drainage of the abscess. We now know from studies that using a needle and syringe to drain the breast under ultrasound guidance is just as effective. This prevents an open wound, scarring of the breast and possible later problems with breastfeeding.

Aspiration (sucking out) should be used for breast abscesses in additionto antibiotics and breastfeeding to ensure optimal results. Sometimes you may need aspirations every 2-3 days for 7-10 days, but there should be improvement in your symptoms.
Breast Thrush
Thrush is a yeast infection which can also affect the breastfeeding breast and can be a source of misery!

It causes severe burning, shooting pains during breastfeeding and causing sore patches and red ulcers on the nipples and areolae. Thrush can be passed between the baby’s mouth and the mother’s breast during breastfeeding so reinfection can occur despite continued treatment.

Seek advice early if you are having pain during breastfeeding, it may not be thrush but it can always be helped. Remember that Thrush is a rare cause of breast pain. Most commonly pain is cause by latching and feeding problems that have simple solutions. Don’t start medicine for thrush before you are certain that that is the cause.

If it is thrush, it is important to treat mom and baby at the same time and for long enough to ensure all infection is gone. For deep thrush, you will need an anti-thrush medicine orally as well as an anti-fungal cream for your nipples, and an oral gel for the baby’s mouth. Specialist support is also important as the pain can discourage you from continuing breastfeeding.

Seek help early. Great information for Thrush is available here but you should be examined and started on treatment by someone used to treating the problem.