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Plugged ducts and mastitis are the
traffic jam of lactation.
Mastitis means inflammation of the breast - and inflammation can narrow ducts causing a slow-down in flow - often called a “plug”. Usually this can be relieved with some extra attention - gentle massage, nursing/pumping normally (not over-feeding or over-pumping), anti-inflammatory measures (cold packs, taking anti-inflammatories). In the past many people were advised to use warmth and vibration - however, sometimes these measures exacerbate inflammation so you want to be very cautious with them (or avoid all together). Remember the breast is a gland, not a muscle - we would never advocate heat and vigorous massage for any other gland in the body!
Consult the resources below - if the blockage/inflammation persist and/or becomes further enlarged - then you want to call your physician - ideally an MD/IBCLC, but your OB or GP is a good option as well because things can worsen and creating an infection or even an abscess.
For any mastitis - doing the work to alleviate the inflammation is essential. The resources below can help you get started. However you also want to work with your IBCLC to determine the reasons why you are getting mastitis, and how to alleviate/avoid it in the future. Reasons could be from too high supply, or issues with latch/less effective “milk removal” (and this can be true even if the baby is gaining weight), less effective pumping, or an imbalance of the correct amounts of nursing/pumping for your body. When these things happen, it leaves too much milk in the breast - causing milk stasis and inflammation.
I like a traffic jam analogy for mastitis - if you had a traffic jam you wouldn’t put more cars on the road (pumping or nursing excessively), or narrow the road further (squeezing the breast, massaging so hard/heating too much so there’s more inflammation). Instead you would make sure to widen/clear the road (reduce inflammation) and allow a regular flow of cars (normal amounts of effective nursing or pumping).
Here are my favorite plugged ducts/mastitis resources and ideas
Anti-inflammatory measures: cold compresses and/or anti-inflammatories between nursing and pumping - the purpose is to control inflammation, which is the main issue causing pressure on the system. An over the counter anti-inflammatory can be taken, but officially you want to ask your physician which one.
Gentle breast massage, including massaging fluid back into the lymph system (too much fluid increases inflammation and pressure).
Another Lymphatic Drainage Massage video
Therapeutic Breast Massage (this video also shows an excellent demonstration of hand expression - which is also a very effective way to move the milk very specifically from one portion of your breast by moving your fingers to different orientations (more on my hand expression page as well)
Breast Gymnastics - it’s gentler than it sounds! Gently stretch your breasts away from the chest wall, and then gently move them around in circles or up/down, side-to-side. This opens up room in the breast, allowing for more lymphatic drainage, reducing inflammation and helping to move the milk forward. When you “stretch” your breasts, it feels good - kind of in the same way that stretching a sore muscle feels.
Here’s a 2nd one on breast gymnastics
And, recently a colleague and I were told that Breast Gymnastics is like the Hokey-Pokey - so we made up this Breasty-Pokey song.
Sometimes dangle nursing (or dangle pumping) helps people alleviate plugs - I suspect it acts a bit like breast gymnastics - stretching the breast tissue away from the chest wall.
If you are pumping, flange fit and pump settings are crucial! See my pumping page for more info.
Milk blisters (also called “blebs”) - they are like a plugged duct on the surface (a plugged pore) so they are also related to how the milk is flowing.
I recommend alternating olive oil soaks (to loosen the surface of the bleb) with and saline soaks (1/2 - 1 tsp table salt in 8 oz water (or you can get a commercial saline rinse product). The idea is to loosen up the bleb so that the milk can fully flow. For that reason, how the milk is flowing is related - so if a baby’s latch is compressing you that could limit the flow, or if flange fit/pumping is not as effective - that can also limit the flow.
You want the milk to pass through the duct in an effective enough manner that it “flushes” it out. One way to customize how the milk is flowing through that pore/duct is to use hand expression - try your fingers in various angles to see if you can get the milk to move through that particular port more.
Avoid excessive heat, massage and vibration - these can increase inflammation, especially if overused.
If you feel that it helps you to manipulate your breast better - you can use gentle warmth (but not hot!) and massage before nursing or pumping. But, again, avoid excessive heat and overly vigorous massage.
Remember that the location that is “clogged” is actually between where you feel the lump/inflammation and the nipple, so aim your massage between where you feel the inflammation and nipple (you are “clearing the path” for the milk to flow out)
Use of vibration has been touted as a good method. And, like massage, it can be but it’s important to not overdo it - overly vigorous vibration (or massage) or pressing the vibration deep into your tissue increases inflammation.
Lecithin treatment is falling out of favor because long-term lecithin may cause GI issues, and the active ingredient is actually choline. So, you may be better off seeking other options such as choline supplements, increasing consumption of omega-6-rich foods, or taking some newer products to the market that contain choline and breast-healthy probiotics - they are from Lactation Hub or Holistic Lactation.
Other comprehensive pages on plugged ducts/mastitis
from KellyMom - One, Two, as well their page on breast abscess
The Breastfeeding Medicine Protocol for Mastitis - updated in 2022.