Revised information on dealing with blocked ducts and mastitis
by Cordelia Uys, Breastfeeding Counsellor
March 2023
It is now believed that previous advice to apply heat and to vigorously massage the breast when a mother has a blocked duct or mastitis is not helpful and can make the situation worse.
This is what IBCLC lactation consultant Lucy Webber has written:
A common self-help suggestion for mastitis is massage. The idea being, that milk is backed up and needs dispersing, and that massage may help to break down any thickened blockages and allow milk to flow. In 2021, at the Lactation Consultants of Great Britain conference, we received a talk from IBCLC lactation consultant and breast surgeon Katrina B. Mitchell, who encouraged us all to think very differently about this. Mastitis, she reminded us, is largely about inflammation. Swelling that's in the breast tissue. This may have come from a blockage, infection, or both. We often focus on the blockage and the infection, but not enough attention is given to the inflammation, which actually is a major part. When we massage the breast, often vigorously and with implements such as specially designed devices, electric toothbrushes or vibrators, we're actually causing MORE inflammation.
If you think about it, if you sprained your ankle and it swelled up, you're unlikely to vigorously massage it because you'll cause pain and damage. What you'd do is rest it, deal with the pain, and try and bring down the inflammation. So rather than massage the breast down toward the nipple, Dr Mitchell suggests very light touch fingertip massage toward the armpit to try and assist with lymph drainage. Alongside other mastitis treatments too.
This got a lot of us thinking, and it definitely makes sense. As with a lot of things breastfeeding related, we could do with more research!
Blocked ducts
Instead of applying heat and doing lots of vigorous massaging, Dr Katrina B. Mitchell suggests:
Applying cold compresses to the affected area between feeds. You can make an excellent cold compress by pouring cold water into a clean nappy and placing it in the freezer for an hour.
Doing gentle lymphatic drainage massage. See Breastfeeding Medicine of Northeast Ohio’s link below for the basics of therapeutic breast massage: https://player.vimeo.com/video/65196007
Breast gymnastics can also be very helpful: https://fb.watch/lp2SD57Pzy/
Breast gymnastics video on Instagram: https://www.instagram.com/reel/Cc8cuq-FDZn/?igshid=MzRlODBiNWFlZA==
In addition:
Try different positions. Breastfeeding while leaning over your baby, known as dangle feeding, can be helpful.
Therapeutic ultrasound can be extremely effective at clearing blocked ducts and can help prevent mastitis. Dr Katrina B. Mitchell said this is okay as it’s gentle. Therapeutic ultrasound can also be effective at clearing mastitis, and may mean antibiotics aren’t needed, but more sessions are usually needed once a mother has full blown mastitis. https://www.cordeliauys.co.uk/therapeutic-ultrasound
Mastitis
If a blocked duct isn’t dealt with quickly, milk can to seep out of the duct into the surrounding breast tissue, causing an inflammatory reaction, which is known as mastitis. Usually this presents as a red, hot, swollen and painful area on the breast, larger than when there is just a blocked duct. (On darker skin, there might not be redness).
Sometimes mastitis can be resolved in the same way as a blocked duct, but if a mother develops a temperature, starts to feel fluey, or if symptoms are not improving within 12-24 hours, a mother should contact her GP as antibiotics might be necessary. The antibiotic of choice for treating mastitis is usually flucloxacillin 500 mg four times a day for 10–14 days. Flucloxacillin is compatible with breastfeeding.
In addition:
Rest as much as possible. Mastitis requires bed rest.
If normally tolerated, paracetamol and ibuprofen can be taken.
NB. Ibuprofen 200-400mg should not be taken more than 3x/day. Higher doses may be prescribed under a doctor’s guidance: https://www.nhs.uk/medicines/ibuprofen-for-adults/#:~:text=The%20usual%20dose%20for%20adults,least%206%20hours%20between%20doses
When a mother has mastitis, it’s very important that she continues to remove milk from her both her breasts very regularly, either by breastfeeding or by pumping as otherwise she could develop a breast abscess. Her milk will be safe for her baby to drink.
Causes of blockages
A shallow latch - see a breastfeeding professional to check latch and check for tongue-tie. Taking a full history will allow them to fully assess the cause of blockages and nipple damage. Milk not being removed efficiently can cause block ducts and also affect supply so should be addressed as soon as possible
Always wear a correctly sized bra that is fitted and regularly check it’s the right size. Wearing clothes which are too tight or with parts that dig in can also cause blockages
A mother holding her breast firmly during a feed.
Baby’s arms or fingers can dig in when feeding/sling wearing so worth making sure nothing is uncomfortable or digging into your breast.
Toddlers can also cause blockages if they dig in elbows, knees or feet.
A tongue-tie.
Lecithin
Some women find they need to take lecithin regularly to keep blebs and blocks at bay:
https://kellymom.com/nutrition/vitamins/lecithin/
Breastfeeding when experiencing pain in the nipple or breast due to nipple damage, blocked duct or milk blister/bleb
Try to get as deep a latch as possible: a mother’s nipple needs to be far back in the baby’s mouth at the junction of the hard and soft palate, not at the front where the nipple will be pushed up against the baby’s hard palate. The deeper the latch, the further back the nipple will go in the baby’s mouth. Good attachment and positioning will often help to prevent further damage.
The flipple technique can help achieve a deep latch: https://www.youtube.com/watch?v=41fC0fQs1P8
When dealing with nipple damage feed baby from the non-injured side first as babies latch and sucking will be stronger on the first breast and gentler on the second breast
Feed in a different position that is more comfortable. You could try the rugby hold if you normally feed in cradle position. This should help avoid damaged part of breast while it heals.
Research has shown that the baby-led/laid-back position reduces pain and damage for many mothers:
Links:
https://breastfeeding.support/mastitis-symptoms-and-treatment/
https://www.cordeliauys.co.uk/treating-a-nipple-bleb
https://www.cordeliauys.co.uk/moistwoundhealing