Hi Ami,
A severely engorged breast would be helped by cold, to decrease swelling.
Heat would bring more blood and lymph to the area, making things worse.
A mildly engorged breast (full but with some "give" in the tissues, could
release milk with some massage and warmth (not hot).
For mastitis, warmth is usually helpful when mother is expressing to keep
that breast drained. To help fight infection, blood bringing infection
fighting cells, and lymph to clear things out, would be helped by warmth.
But...If the mastitis is a result of severe engorgement, when the breast is
red and shiny and very very hard and tight, I would use cold because the
mastitis is a result of severe milk stasis which we would not want to
increase the blood or lymph to the breasts at that point. Once the milk got
flowing however and the breasts were looser, warmth often helps when mother
is expressing.

Hope I am making sense.
Laurie Wheeler RN MN IBCLC
MISSISSIPPI USA

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