I’m so excited to be able to share new evidence-based information on plugged milk ducts with you! And I’m even more excited that this knowledge has come forward and honestly has made breast care much simpler for lactating parents and clinicians alike. The Academy of Breastfeeding Medicine updated the protocol on the Mastitis spectrum this year (2022) which includes care for plugged ducts.
At some point during lactation, you may notice a discrete lump or ball in the breast. You may feel a small area that feels hard compared to the rest of the breast. This can often feel tender or painful. This can be referred to as a plugged duct. But as you will read, this name is kind of misleading.
The internet still largely contains outdated and potentially harmful information on managing breast care with plugged ducts when lactating. Some remedies that you should avoidare: applying heat, soaking your breasts in water and Epsom salt, deeply massaging the breasts, utilizing vibrational tools on the breasts, nursing more often, and pumping more often. These methods were all employed with the goal of unplugging trapped milk. Unfortunately, that isn't the problem. So they don't work. And these methods also will actively make the problem worse.
So what's really going on in your breast?
Trapped milk is not the problem. The lump or hard area you feel in the breast is mainly inflammation and not milk that is trapped. If you massage it, you will increase inflammation and worsen the symptoms. “ A breast “plug” represents a focal area of swelling in the breast and more accurately reflects lymphatic fluid congestion and dilated capillaries than a discrete “plug of milk.”” (Mitchell, 2022).
In other words, it's not milk! Your breast tissue is inflamed and there is extra fluid (not milk) collecting in breast tissue (not ducts) to deal with the problem. If we bring down the inflammation, the symptoms will resolve. Milk eventually can start to have more trouble moving around in this area if it persists. But the solution is to use ice to decrease inflammation. This allows symptom resolution and gives your milk a free path to move again.
According to the ABM (2022) “Ducts in the breast are innumerable and interlacing (Figs. 6–8) and it is not physiologically or anatomically possible for a single duct to become obstructed with a macroscopic milk ‘‘plug.’’”
Imagine spraining your ankle. It swells up and then you apply heat to it and begin vigorously and deeply massaging it. Ouch, right? It will swell more. And if we do this to our breast tissue, the inflammation will worsen. This can lead to tissue trauma. The overall guiding principle for breast care is Be Gentle! No massage is needed! When following good breast care for a plugged duct, you should feel symptoms improving within 24hr.
Now lets get to treatment:
~Continue your normal regimen of milk removal. This means don’t pump or nurse more often due to a plug. Continue your normal routine. If you add extra stimulation to the breast that has a plug, you will increase supply and add more milk to a congested area. This will worsen the problem.
~ICE! Apply ice after nursing or pumping for 8-10 minutes (not longer than 15 minutes at a time. Do not apply ice directly to your skin. Cover it with a cloth)
~Ask your Physician if you can take an anti-inflammatory.
~Adding a technique called Lymphatic Drainage can sometimes be called for if there is a lot of extra congestion in the breast. Please discuss this with your IBCLC.
Most of my clients who have followed these steps have reported relief within 24hr. If you have recurrent plugged ducts, work with your IBCLC to discover why and stop the cycle!
Mastitis is a blog for another day but please reach out to your IBCLC and an MD if your symptoms are not improving and you see things progressing. Signs of mastitis are: *Breast tenderness or warmth to the touch. *Breast swelling. *Thickening of breast tissue, or a breast lump. *Pain or a burning sensation continuously or while breastfeeding. *Skin redness, often in a wedge-shaped pattern. *Generally feeling ill. *Fever of 100.4 F (38.3 C) or greater. Please call your MD if you have these signs and symptoms
Please remember that there are Two kinds of Mastitis: Inflammatory mastitis and Infectious mastitis. You don't always need antibiotics. Consult your IBCLC and Physician!
Mitchell, K., Johnson, H., Rodrıguez, J.M., Eglash, A., Scherzinger, C., Zakarija-Grkovic, I., Widmer Cash, K., Berens, P., Miller, B., and The Academy of Breastfeeding Medicine. (2022) Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, 17 (5), 360-376. https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf
Mitchell, K. (2022, September 13). Mastitis and associated complications. Physician Guide to Breastfeeding. Retrieved September 18, 2022, from https://physicianguidetobreastfeeding.org/maternal-concerns/mastitis-and-associated-complications/?highlight=%22plugging%22