COMMON CONDITIONS

Plugged Ducts

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summary

A plugged duct is a focal point of congestion and inflammation of the breast caused by an accumulation of lymphatic fluid, dilated capillaries and milk that can cause pain, tenderness and engorgement due to obstruction of flow and circulation. We used to think plugged ducts were a literal “plug” of milk that blocked flow of milk through the ductal network. We now know that the anatomy of the breast does not support that theory. We do not need to remove or push a plug through the breast. We need to reduce inflammation to allow the ductal network to open and flow optimally.

Plugged ducts generally resolve within 24-48 hours with treatment at home. To heal a plugged duct, we focus on treating inflammation thus reducing swelling in the breast to allow milk ducts to open and milk to flow. To achieve this we recommend regular breastfeeding, hot and cold compresses, anti inflammatories , gentle massage techniques, and hand expression or pumping, as needed only (sparingly).

Equipment Needed:

• Cold compresses
• Warm compress, unless the breast is hot to touch (optional)
• Anti-inflammatory medication (NSAIDs, such as ibuprofen) as directed by your healthcare provider (HCP)
• Edible oil such as olive or coconut oil for massage (optional)
• Breast pump (optional)
• Lecithin (as directed by your HCP)

Steps:

  1. Breastfeed on demand or pump on your regular schedule ensuring that breast is drained at each feed or pumping session.
  2. Alternate warm and cold compresses to the breast for 10-20 minutes each, being careful not to burn your skin with either compress. *Do not apply heat to the breast if it is already hot to the touch, instead use cold.
  3. As directed by your HCP, alternate ibuprofen and tylenol as needed for pain, for three days.
  4. Consider taking sunflower or soy lecithin 5-10 grams daily by mouth as directed by your HCP. Lecithin may help reduce inflammation and encourage milk flow through the ductal network.
  5. Perform gentle massage, using therapeutic breast massage or lymphatic drainage techniques, and hand expression before and during breastfeeding. It is important to avoid deep pressure or aggressive massage techniques. Intense massage can cause bruising, swelling, and increased inflammation in the breast, making draining the plugged area more difficult and increasing the likelihood that it will progress to mastitis, phlegmon and/or abscess.

Follow Up:

If plugs do not resolve within several days, or recur frequently, even in the absence of mastitis symptoms, assessment by a physician and qualified lactation professional is recommended and referral for breast imaging may be warranted.

Resources:

Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. BREASTFEEDING MEDICINE Volume 17, Number 5, 2022 ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2022.29207.kbm

ABM Clinical Protocol #30: Breast Masses, Breast Complaints, and Diagnostic Breast Imaging in the Lactating Woman. Breastfeeding Medicine, 14(4), 208–214.

Zhao, C., Tang, R., Wang, J., Guan, X., Zheng, J., Hu, J., Hu, G., & Song, C. (2014). Six-Step Recanalization Manual Therapy. Journal of Human Lactation, 30(3), 324–330.

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