Clogged Ducts and Mastitis

If you’ve ever had a painful lump in your breast while breastfeeding, you may have been told that you have a blocked or clogged milk duct.

And if you’ve breastfed before, some of the advice you were given may have included massaging the lump firmly, applying heat, feeding repeatedly from that breast or pumping to “empty” it.

Our understanding has changed.

In 2022, the Academy of Breastfeeding Medicine published updated guidance on what it now calls the mastitis spectrum. Rather than thinking of a clogged duct as a little plug of milk that needs to be squeezedor sucked out, we now understand that inflammation and swelling can narrow the tiny milk ducts within the breast.

This matters, because some of the things traditionally recommended to “clear a blockage” can actually increase inflammation.

Why do clogged ducts happen?

Your breasts contain a network of tiny ducts carrying milk towards the nipple. If the tissues around these ducts become inflamed and swollen, the ducts can narrow and milk may not flow as freely.

You might notice a tender or firm area of the breast, discomfort, swelling or redness.

One factor that can contribute is making or removing more milk than your baby needs.

This is particularly relevant in the early weeks, while your milk production is still settling down.

If you repeatedly feed from the affected breast, add extra pumping sessions or pump until the breast feels completely “empty”, your body receives the message that more milk is required.

More milk production can mean more fullness and congestion – potentially contributing to further inflammation.

So although it can feel counterintuitive, more milk removal isn’t necessarily the answer.

Should I try to empty the breast?

No breast is ever truly empty, milk is continuously being produced.

If you are breastfeeding, continue feeding your baby responsively and normally rather than repeatedly offering the sore breast simply to try to clear it.

If you are pumping, aim to express approximately the amount your baby needs rather than repeatedly pumping to empty the breast.

If you are very full and uncomfortable, gently hand expressing a small amount of milk for comfort may help.

The aim is to keep breastfeeding going without inadvertently encouraging your body to produce substantially more milk.

What about massage?

This is another area where advice has changed.

Deep or vigorous massage of a painful area is no longer recommended.

If the tissues arealready swollen and inflamed, pressing hard, kneading the breast or trying to force a supposed “plug” towards the nipple can cause further tissue trauma and inflammation.

The same applies to using vibrating devices such as electric toothbrushes or massagers to try to break up a blockage.

If touch feels soothing, think very gentle rather than deep. Light strokes over the skin may feel comfortable, but you don’t need to try to squeeze anything out.

Heat or cold?

Traditionally, breastfeeding mums were often advised to use lots of heat on a blocked duct.

Current advice tends to favour cold packs to help reduce swelling and discomfort.

Wrap something cold in acloth rather than putting it directly against your skin.

An anti-inflammatory medicine such as ibuprofen may also help with pain and inflammation if it is normally safe for you to take. Follow the instructions provided with the medicine or speak to your pharmacist or doctor if you’re unsure.

Does mastitis always mean an infection?

No! Another important change is that mastitis is now thought of as a spectrum.

Inflammation and ductal narrowing can progress to inflammatory mastitis. Some cases may then develop into bacterial mastitis, but having a red, sore breast doesn’t automatically mean that you have a bacterial infection or need antibiotics.

Many inflammatory symptoms can settle with rest, cold packs, appropriate pain relief, normal breastfeeding and avoiding excessive pumping and aggressive massage.

Antibiotics may be needed when bacterial mastitis is suspected.

You can usually continue breastfeeding, including from a breast affected by bacterial mastitis.

Why do I keep getting clogged ducts or mastitis?

If this is happening repeatedly, it’s worth looking beyond each individual episode and asking why it keeps happening.

For example, are you producing more milk than your baby needs? Have you been pumping in addition to breastfeeding? Are you pumping for longer than necessary? Is your pump flange comfortable and appropriately fitted?

Are you using very high suction? It can also be useful to look at how breastfeeding itself is going.

Rather than continually trying to “unblock” the same breast, identifying factors that may be contributing to inflammation or oversupply can sometimes help break the cycle.

When should I get medical help?

If you are becoming increasingly unwell, have worsening or spreading redness or swelling, persistent fever or flu-like symptoms, or you’re not beginning to improve with conservative measures, seek medical advice.

Some cases of mastitis require antibiotics and occasionally an abscess or another complication can develop that needs medical treatment.

If you’re simply unsure, it’s always reasonable to ask for help.

Breastfeeding support inJersey

If you are struggling with recurrent clogged ducts, mastitis, oversupply or pumping – or you are simply finding breastfeeding more difficult than you expected, you don’t have to work it all out by yourself.

Sometimes looking at the whole feeding picture can help identify relatively small changes that may make breastfeeding more manageable.

I offer breastfeeding support in Jersey through home visits and appointments at my clinic in St Helier.

Penny Henderson
Breastfeeding Coach & Chiropractor
Breastfeeding Jersey

This article provides general breastfeeding information and does not replace individual medical advice. If you are unwell or concerned about mastitis, please contact your GP or another appropriate healthcare professional.

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