What to do about plugged milk ducts and mastitis while breastfeeding

Breastfeeding comes with many rewards, but it can also bring a few challenges along the way. One of the most common concerns new mothers experience is what used to be called a "plugged" or clogged milk duct.

Recent guidance from the Academy of Breastfeeding Medicine has changed how experts understand and treat this issue. What many people refer to as a clogged milk duct is now recognized as inflammation around a milk duct, which narrows the duct and slows milk flow.

When this inflammation isn't resolved, it can sometimes progress to mastitis, a painful breast condition that may require medical treatment. 

The good news is that with the right care, most cases improve quickly.

What causes a clogged milk duct while breastfeeding?

Plugged ducts usually happen when milk isn't removed effectively from the breast. When milk backs up, inflammation can develop around the duct, which restricts milk flow and causes discomfort.

Common causes may include:

• Infrequent feedings or pumping sessions
• Ineffective latch or shallow latch during breastfeeding
• Long gaps between milk removal (for example, while at work)
• Tight clothing or bras that place pressure on the breast
• Diaper bag or purse straps that compress breast tissue

If inflammation continues without improvement, it can lead to mastitis, which is a more serious condition.

Symptoms of a clogged milk duct

Symptoms can vary but often include:

• A tender or painful lump in the breast
• Breast swelling or localized firmness
• Redness in one area of the breast
• Decreased milk output from the affected breast
• Pain or discomfort during feeding or pumping

These symptoms are typically limited to one breast, not both.

How to treat a clogged milk duct.

Current recommendations focus on reducing inflammation while continuing normal milk removal.

Continue breastfeeding or pumping

Continue nursing your baby on both breasts, including the affected side. Regular milk removal helps relieve pressure and support healing.

If you're exclusively pumping, continue pumping at your normal schedule, typically every three hours.

If the affected breast temporarily stops releasing milk, pause pumping and apply cold compress until inflammation improves. Milk flow usually returns once swelling decreases.

Apply cold compress

Ice packs or cold compresses can help reduce swelling and inflammation. Apply them to the affected area between feedings or pumping sessions.

Use anti-inflammatory medications

Over-the-counter medications such as ibuprofen or acetaminophen may help reduce inflammation and relieve discomfort. Always follow your provider's guidance. 

Avoid aggressive massage

Gentle massage is acceptable, but firm massage or commercial breast massagers should be avoided. These can increase inflammation and make symptoms worse.

Signs and symptoms of mastitis

Mastitis often begins as inflammation but can develop into a breast infection if symptoms worsen.

Symptoms may include:

• Redness affecting one breast 
• Breast swelling or hard, painful area
• Flu-like symptoms or body aches
• Decreased milk supply from the affected breast
• Fever 100.5 degrees F or higher

If you develop a fever or worsening symptoms, contact your OB provider or midwife. Antibiotics may be needed if infection develops.

It's important to know that mastitis does not contaminate breast milk, so it's safe to continue nursing your baby. 

How to prevent clogged ducts and mastitis 

Prevention plays a key role in maintaining breast health during breastfeeding.

Tips to help prevent clogged milk ducts include:

• Nurse on demand and follow your baby's feeding cues
• Ensure a deep latch so the breast drains well
• Pump regularly if separated from your baby for more than two to three hours
• Wear a supportive nursing bra that is not tight or restrictive
• Avoid pressure from clothing, purse straps, or diaper bag straps.

If mastitis occurs, getting plenty of rest, drinking fluids, and eating small frequent meals can support recovery. Milk supply often returns to normal once inflammation resolves. 

Breastfeeding support at Touro

Breastfeeding support can make a big difference, especially when challenges arise. The lactation specialists at the Touro Lactation Center are here to help with breastfeeding questions, latch concerns, milk supply issues, and breast health.

If you need guidance or support, our team is here for you.