This article was on Medscape.   Here is the begining.  It does recommend consultation with a lactation consultant as art of the treatment (although ideally it would have said IBCLC)

Winnie Mading

September 25, 2008 - Recommendations for diagnosing and treating mastitis in mothers who are breast-feeding their infants are reviewed in the September 15 issue of American Family Physician.

"Although [mastitis] can occur spontaneously or during lactation, this discussion is limited to mastitis in breastfeeding women, with mastitis defined clinically as localized, painful inflammation of the breast occurring in conjunction with flu-like symptoms (e.g., fever, malaise)," writes Jeanne P. Spencer, MD, from Conemaugh Memorial Medical Center in Johnstown, Pennsylvania. "Mastitis is especially problematic because it may lead to the discontinuation of breastfeeding, which provides optimal infant nutrition....To extend breastfeeding duration, family physicians must become more adept at helping mothers overcome breastfeeding difficulties such as mastitis."

The Healthy People 2010 goals for breast-feeding are that 75% of mothers start breast-feeding their infants, that 50% continue to 6 months, and that 25% continue to 12 months. However, most states failed to achieve these targets as of 2005. Mastitis, which occurs in approximately 10% of breast-feeding mothers in the United States, can cause mothers to stop breast-feeding.

Mastitis is usually diagnosed clinically from the characteristic presentation of focal tenderness in 1 breast, associated with fever and malaise.

To decrease the risk for mastitis, breast-feeding technique should be optimized, and the breast should be emptied frequently and completely. Mastitis may be triggered by sore nipples, which in turn may result from mechanical irritation from a poor latch, infant mouth anomalies including cleft palate, or bacterial or yeast infection.

Other risk factors for mastitis may include cracked nipples, local milk stasis, missed feeding, nipple piercing, use of plastic-backed breast pads, poor maternal nutrition, history of previous mastitis, primiparity, restriction from a tight bra, short frenulum in the infant, and/or use of a manual breast pump.

Blocked milk ducts, presenting as localized tenderness in the breast from inadequate milk removal from 1 duct, can also cause mastitis. A firm, red, tender area is typically present on the affected breast, often with a painful, white, 1-mm bleb on the nipple. It may be helpful to remove the bleb with a sterile needle or by rubbing with a cloth. Frequent breast-feeding, warm compresses or showers, massaging the affected area toward the nipple, and avoiding constrictive clothing may also help relieve blocked milk ducts.

A lactation consultant may assist in the treatment of mastitis by recommending changes in breast-feeding technique.

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