Understanding Plugged Ducts

If you’ve ever had a plugged duct, you know how miserable they can make you.  They are painful, sometimes provoke anxiety, and can lead to decreased milk production (temporarily).  Contrary to what you might think, plugged ducts are not little clumps of milk but Instead they are areas of obstructed milk due to inflammation that has developed in or around a milk duct. This inflammation gradually narrows the duct, making it difficult for milk to flow freely. While there may be a bit of congealed milk involved, it's primarily inflammation that's causing the blockage.  

We in Breastfeeding Medicine are brainstorming other terms to use for these particularly pesky problems - “inflammatory ductal narrowing,” or “ductal blockages from inflammation,” have been proposed.  I tend to continue to use “plugged ducts” since most people know the clinical situation I’m referring to when I talk about them, but it’s important to start to think about them in this different way in order to treat them in the safest way possible.  

OLD Recommendations for Managing Plugged Ducts

You may have heard various recommendations for dealing with plugged ducts, such as:

• Massage and Pressure: Some advise pushing and massaging the affected area to try to “push out the plug.”

• Heat: Applying heating pads over the breast is another suggestion.

• Vibrating Devices: Electric toothbrushes or similar vibrating tools have been recommended for breaking up blockages.

• Dangle Feeding: The dangle feeding position - leaning forward on all fours while nursing -  theoretically uses gravity to your advantage in clearing a plugged duct.

While these methods may provide some relief, they don't address the root cause of plugged ducts – inflammation in the milk ducts.  In fact, these methods can make the inflammation worse by producing more trauma to the ducts, and while one may experience temporary relief, these can actually increase your chance of having recurrences.  Dangle feeding doesn’t hurt anything (except maybe your knees!), but it probably doesn’t help, either. 

Managing Plugged Ducts Effectively

Now, let's discuss more effective ways to manage plugged ducts:

• Anti-Inflammatory Medication: Consider taking anti-inflammatory medications like ibuprofen to reduce inflammation and pain.

• Cold Compresses: Apply ice to the affected area of the breast to decrease inflammation. Cold therapy, similar to treating a sprained ankle, can be surprisingly effective.

• Lymphatic Massage: Instead of forceful massage, opt for gentle lymphatic massage or drainage techniques. This involves gentle lifting or tapping of the breast, gentle circular motions, and gentle stroking towards the armpit to encourage fluid drainage. This method is less aggressive than the typical recommended massage and can help reduce inflammation instead of causing more.

• Lecithin: Lecithin supplements can help make milk particles less sticky, reducing the likelihood of clumping and congealing in the ducts and making it easier for milk to continue to flow even when the ducts are narrowed from inflammation..

• Frequent Milk Removal: Ensure you're regularly removing milk from your breasts.  This does not mean removing way more than your baby is eating if you have an “oversupply,” but instead nursing on demand and if pumping, attempting to remove the volume that your baby is eating and not much more (assuming a healthy full-term baby).  You do not need to “empty” your breasts unless you are not making enough milk for your baby and are actively trying to increase your production.  If you are experiencing engorgement due to less frequent milk removal (for instance, if your baby is sleeping a longer stretch at night or you are actively changing your pumping schedule), you may need to do some hand expression and lymphatic massage in between more “full” nursing or pumping sessions to help decrease the buildup of inflammation you are experiencing during engorgement (see our BLOG about Engorgement here).

• Patience!:  If you follow the above guidelines and simply give it time, any areas of swelling or “plugs” should resolve within a few days.  Key Take-Away:  Avoid Aggressive Approaches

It's essential to avoid aggressive techniques like excessive, deep massaging or using vibrating devices. These can cause more harm than good by increasing inflammation in the breast tissue. Remember that your breasts are sensitive organs (they are glands, like your thyroid or pancreas), and treating them gently is of utmost importance.

When to Seek Help

If you experience persistent or recurrent plugged ducts, or if a lump remains unchanged for weeks, it's essential to consult a healthcare professional. Also, a lump that is also associated with fever, chills, or sweats could be a developing infection and needs medical evaluation.  A Breastfeeding and Lactation Medicine Physician, a breast surgeon, your OB-GYN or midwife, or your primary care doctor can help evaluate your situation and rule out any underlying issues.

Conclusion

Dealing with plugged ducts can be uncomfortable, but it's important to manage them effectively and gently. Avoid aggressive methods, focus on reducing inflammation, and consult a healthcare professional if needed. Trust that your body can resolve plugged ducts with proper care and patience.