Breastfeeding: Unplugged (Plugged ducts and how to fix them)
Updated: Jan 8
Many mothers report that they feel small lumps in their breasts during breastfeeding. They may describe it as feeling like little beads, frozen peas, or marbles under their skin either with or without pain. Some lumps disappear after a feed, never to return, some disappear and then return right before the next feeding, and other lumps seem to take a few days or weeks to disappear.
What are plugged ducts and why are they there?
This condition is what is known as a plugged (or clogged) duct and it usually occurs when something impedes the flow of milk from the breast, either from outside pressure like an underwire bra or from inside such as when the milk itself becomes thicker making it difficult for the milk to travel through the interconnected ductal network and out of the breast. Most often we see plugged ducts occur when milk has stayed in the breast for too long due to either not feeding frequently enough, having too much milk from engorgement or oversupply causing the breast not to be drained well enough, or from extra pressure exerted on that area due to something constricting.
What can I do about it?
The first thing to do is to see if you can locate the underlying cause. Here are some possible issues you might consider:
1) Check for causes of external pressure and make the necessary changes as to not impede flow.
Examples might include a tight fitting bra or underwire, breast shells or sleeping positions. Many maternity stores will do bra fittings for pregnant and lactating mothers. Keep in mind that in the first six weeks you may experience a little (or a lot) of engorgement. A spandex-type bra that is flexible enough to expand as necessary works well for the early weeks. A more supportive maternity bra (that fits correctly) works well for the next few weeks and beyond.
2) Remove milk from your breasts frequently and effectively.
This will give you the best possible breastfeeding outcome, especially when it comes to plugged ducts. Increase your total number of feeds over 24 hours by breastfeeding your baby, using a pump, hand expression or combination of all three to drain the breasts really well.
If your baby is physically having a hard time removing the milk, you need to get help from a lactation consultant to help determine the underlying cause.
Reasons why milk might be remaining in the breasts for too long—
Not feeding frequently enough over 24 hours; reduced total daily feeds
The baby is sleeping for longer stretches at night or day
Supplementing without expressing
Not using an effective pump
Restricting feeding time at the breast during each individual session
Weaning to quickly
Scar tissue from previous surgeries or breast implants impeding milk flow
Having excess milk due to oversupply
Engorgement in the first few days post delivery
3) Use massage before, during and after feedings.
Start at the base of the nipple and work your way up slowly until you reach the plugged duct. Keep in mind, that the ductal system is an interconnected network, so where your blockage might appear is not necessarily where it originates. Be sure to massage around the entire breast, not just the local area.
4) Use your baby and warmth.
Position your baby’s chin in the direction of the lump during feedings. Prior to feeding, you can also use warm compresses or warm showers and allow the water to gentle massage the breast.
5) Treat any nipple blebs (blocked nipple pore).
Any blocked nipple pore might restrict milk from flowing out of that duct. A nipple bleb will look like a white pimple at the tip of the nipple. After showering or soaking the nipple, you can gentle rub the surface of the nipple with a clean cloth to remove the skin covering and then breastfeed or hand express in combination with massage to gently release the bleb.
6) Consider lecithin for resistant plugs.
Lecithin is an emulsifier and will help keep the fat droplets found in milk suspended rather than clumped together. A supplement of 1 Tablespoon 3-4 times / day until resolved may help to break up the milk blockage. Be prepared if you express the milk as you may see the milk come out in clumps or with a string-like texture as the blockage is being released. However, use lecithin after first trying the strategies mentioned above.
When is it more than just a blocked duct?
If you notice any symptoms of increasing pain, redness, swelling, chills, or fever please make an appointment to see your doctor for possible symptoms of mastitis, an inflammatory breast condition that may involve a bacterial infection.
If you notice the lump is not going away or does not reduce in size despite trying the strategies mentioned above, please make an appointment with one of our lactation consultants or your physician, as this may be a symptom of another breast condition that needs medical treatment.
Have you experienced a plugged duct? What did you find was the cause? What strategies helped you troubleshoot and resolve the issue?
When you need an extra level of support to help solve your biggest breastfeeding worries, Sonder Health’s board certified lactation consultants are here to help.
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