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Mastitis, plugged ducts and blebs
are the traffic jam of lactation.
Mastitis is inflammation of the breast, not always an infection requiring antibiotics. Inflammation narrows milk ducts, causing a slow-down in flow (often called a “plug”). This may feel like a lump (the milk collecting behind the blocked area), general tenderness, a milk blister/”bleb”, or engorgement. Usually this can be relieved with gentle massage, nursing/pumping normally but effectively (not over-feeding or over-pumping), anti-inflammatory measures.
Hopefully these measures will alleviate the inflammation and avoid infection (which can occur if the inflammation worsens). However you also want to work with your IBCLC to determine the reasons why you are getting inflammation/mastitis. Typically it’s anything that leaves too much milk in the breast - causing milk stasis and inflammation - such as too high a supply, issues with latch or pumping that cause less effective “milk removal” and more.
In the past people were advised to use excessive warmth and vibration - however these measures can actually 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!
I like a traffic jam analogy for inflammation/mastitis - if there was a traffic jam you wouldn’t want more cars on the road (pumping or nursing excessively), or to narrow the road further (squeezing the breast, massaging so hard/heating too much so there’s more inflammation). Instead you would want to widen/clear the road (reduce inflammation) and allow a regular flow of cars (normal amounts of effective nursing or pumping).
However, if the blockage/inflammation persists, becomes further enlarged, becomes more tender, or you develop aches/fever - contact your IBCLC and call your physician - ideally an MD/IBCLC, but your OB or GP is a good option as well because things can worsen to an infection or even an abscess.
Plugged ducts/mastitis resources
Anti-inflammatory measures: cold compresses, castor oil compresses, and/or taking anti-inflammatories between nursing and pumping. We want to control inflammation, the main issue that is putting pressure on the ducts.
Gentle breast massage, including massaging fluid back into the lymph system (too much fluid increases inflammation and pressure too). Here are some videos:
Therapeutic Breast Massage (also shows an excellent demonstration of hand expression - 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 (and here’s another video with breast gymnastics). It’s gentler than it sounds! Stretch your breasts away from the chest wall, and then move them around in circles or up/down, side-to-side (do the “Breasty-Pokey”!).
Stretching your breast makes more “room” for the tissue/ducts - allowing for more lymphatic drainage, reducing inflammation and helping to move the milk forward. When you stretch your breasts, it should feel good - in the same way that stretching a sore muscle feels.
Sometimes dangle nursing (or dangle pumping) helps people alleviate plus/mastitis - I suspect it acts a bit like breast gymnastics - stretching the breast tissue away from the chest wall.
For pumping, flange fit and pump settings are crucial - if you have not had a flange fitting it’s very likely your correct size is smaller than you think it is! See my pumping page for more info.
Lecithin treatment can help make milk less “sticky” but its use is falling out of favor because long-term lecithin may cause GI issues. The “active ingredient” in lecithin is choline - so the new recommendations are to take choline supplements, increase consumption of choline/omega-6-rich foods. Related to this there are some newer products to the market that contain choline and breast-healthy probiotics - such as these from Lactation Hub or Holistic Lactation.
Milk blisters (also called “blebs”) are like a plugged duct on the surface (a plugged pore) and limit milk flow - creating milk stasis and inflammation in the breast.
Alternate olive oil soaks (to loosen the surface of the bleb) with and saline soaks (1/2 - 1 tsp table salt in 8 oz water (there are also commercial saline rinse products) to loosen up the bleb so that the milk can more easily flow.
You want the milk to pass through the duct in an effective enough manner that it “flushes” it out and loosens/lifts off the bleb. One way to customize how the milk is flowing through that pore/duct is to do hand expression with your fingers in various angles to see if you can get the milk to move through that particular port more.
As discussed above, how the milk has been flowing is related to plugs, blebs and breast inflammation - so if baby’s latch is compressing the nipple, or if flange fit/pumping is not fully effective - that can also limit the flow.
Avoid excessive heat, massage and vibration which can increase inflammation, especially if overused. If you feel that warmth helps you to manipulate your breast better - that’s fine - just avoid excessive heat and overly vigorous massage.
The location that is “clogged” is actually between where you feel the lump/inflammation and the nipple, so aim 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 in the past as a good method - like massage, it can be helpful - but it’s important to not overdo it or press deep into your tissue (which can increase inflammation)
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.