Help! I think I have a plugged duct!
Of the many fears that we have when breastfeeding, experiencing a “plugged duct” is up there. The horror stories that we hear about the pain, the lost milk production, the progression to mastitis, are not helping. Like many things about our bodies and the way they function, once we understand what’s happening, it all becomes a lot less scary.
What even is a plugged duct?
If you’ve ever experienced a tender, firm area in your breast while lactating, you’ve likely experienced a plugged duct. They are fairly common.
Unfortunately, there is a lot of misinformation about them on the internet, on social media, and even in our doctors’ offices. This misinformation is based on what we used to believe to be true about plugged ducts.
We used to think that a plugged duct was when milk became thickened by sitting in the breast for too long, and subsequently became too dense to move through the duct.
Based on this belief, we used to recommend pretty aggressive techniques to remedy this problem. The following is no longer recommended and should be avoided:
❌ Aggressive massage, kneading or vibration of the breast tissue. This recommendation was based on our (now outdated) understanding that milk needed to be forced through the duct when there was a plug. Vigorous massage can actually cause MORE inflammation, which is the exact opposite of what we need. FYI: you don’t need to buy special massagers or vibrators for your breast!
❌ Pump to “empty” the breast. Breasts are never actually empty, and leaving some milk in your breasts after nursing or pumping is not, in and of itself, a problem. Pumping more often than you need will probably lead to an overproduction, which is a risk factor for plugged ducts. Pumping excessively can also lead to nipple and areola tissue trauma. Do you see how unhelpful this advice is?!
❌ Using heat excessively. Heat can help with milk release during nursing or pumping, but outside of that, using heat can lead to more inflammation.
❌ Using a silicone milk collector filled with saline water, dangling over your baby while nursing and having your partner suck really hard to bring the milk out. If it feels silly, it probably should be questioned. None of these methods are proven to help and some of them can lead to more problems.
Now that you know what a plugged duct is not, and how NOT to treat it, let’s talk about the current, up-to-date understanding of this common problem.
Milk ducts of lactating breasts. Credit to Peter E. Hartmann and Melinda Boss.
A lactating breast contains many ducts to carry milk, and these ducts resemble the roots of a tree. The ducts carry milk from the lobules, which resemble clusters of grapes.
A “plugged duct” is now understood to be an area of ductal narrowing caused by swelling in the breast tissue. Essentially, the milk gets backed up and can’t move out of the lobules where it’s stored. It’s like a traffic jam when there’s an accident on the highway and four lanes get reduced to one.
The problem is not caused by thickened milk, but instead a plug of thickened milk will be a result of this problem.
“A ‘plugged duct’ is a region of the breast where inflammation has occurred, blocking flow of the milk through the ducts. Milk ducts are super tiny, so it is not caused by just one duct having a blockage of dried or congealed milk. It is a whole region of slowed milk flow due to swelling around the ducts. When the milk cannot move through the ducts, and is static for a period of time, the fat globules can stick to each other, causing ‘plugs’.”
What causes plugged ducts?
Anything that causes swelling in the breast can potentially cause a plugged duct. Here are some:
Overproduction of milk.
A delay in milk removal (such as skipping feeds).
Ineffective milk removal (such as incorrect pump use or a poor latch).
A restrictive bra.
An imbalance in the breast microbiome.
How to treat plugged ducts
In order to understand treatment, we need to think about our breasts just like any other parts of our body. After all, that’s what they are. 😉
If we sprain an ankle, it will become swollen and painful. To treat it, we’ll elevate the ankle, keep ice on it, and take an anti-inflammatory pain medicine like ibuprofen. We would never put heat on a sprained ankle or massage the area vigorously.
We should do the same with our breasts when there’s swelling.
The following is updated guidance on treating plugged ducts:
✅ Continue to feed your baby whenever they want. With milk production, demand drives supply. We want our bodies to understand how much milk to make by letting the baby set the demand. If your breast has an area of swelling after a feed, DO NOT try to “empty” your breast with pumping. Instead, treat the swelling.
✅ Be sure milk is being removed effectively, by your baby or your pump. If you have concerns about this, contact a lactation consultant to do a feeding or pumping assessment. Hand expression may be a better way to move milk from your breasts when you are dealing with swelling.
✅ Make sure your breasts are being well supported by your bra. Overly tight or underwire bras can cause restrictions in the breasts. For larger breasts, if they aren’t well supported, the pressure caused by your breasts may restrict healthy flow of fluids, including milk.
✅ Ice, ice, baby! Grab whatever you’ve got in your freezer and place that on the swelling. Use ice as often as is comfortable for you. You may find it most helpful between feeds.
✅ Take anti-inflammatory meds. Using an NSAID like ibuprofen will reduce pain as well as inflammation. For acute treatment of swelling, take it every 6 hours. Be sure this is safe for you given your medical history. If you’re not sure, check with your doctor.
✅ Use lymphatic massage. This is the opposite of the type of massage we used to recommend. Lymphatic massage is using the flat of your hand to GENTLY sweep from the swollen area of your breast UP towards your armpit, where you have a lot of lymph nodes. This helps your body move excess fluid back to the lymphatic system. Try to do this at least 4x per day, ideally right before nursing or pumping, but do it whenever you can.
✅ Breast gymnastics: Gently moving your breast around will also help mobilize fluid to create good flow of blood, milk and lymphatic fluid. Perform this as often as lymphatic massage. These techniques can be done together in the same session.
Will plugged ducts progress to mastitis?
If left untreated, breast swelling will increase your risk of mastitis. In addition to the above treatment, try to get as much rest as possible. Call in your support system and stay home from work if you can. Ideally, you can get into bed with your baby and nurse whenever they want.
If you’re experiencing body aches, chills, a fever and increasing tenderness, redness and swelling in your breast, start working on the above plugged duct treatments. If your symptoms worsen, or don’t improve after 24-48 hours, consider calling your provider. You may need antibiotics.
To read more about taking care of your lactating breasts, check out my blog post called “We need more breast kindness.” Our breasts do so much for us and our baby during breastfeeding - let’s learn how to treat them well.
