A “plugged duct” is a simplified term for an area of milk duct swelling and congestion in breastfeeding patients. Often several ducts are affected in an aggravated area. Plugged ducts, especially when unmanaged, can lead to a decrease in milk supply and/or mastitis. Mastitis is a spectrum of breast inflammation with or without bacterial infection.
Common causes of plugged ducts are skipped feeds, poor milk drainage from the breast, and oversupply. Pumping and excess stimulation of the breast can also contribute to plugged ducts. There is emerging evidence that recurrent plugged ducts may also be related to a disruption in the microbiome of the breast, which can occur for a variety of reasons such as breast pump or antibiotic use.
Management of plugged ducts:
- Breastfeed frequently in response to hunger cues
- Breast pumps can overstimulate the breasts, worsening plugged ducts. If pumping is a part of your feeding plan, we recommend meeting with a lactation consultant to ensure proper breast pump usage.
- Previous recommendations of heat and massage are outdated, as heat can contribute to inflammation and massage can cause tissue damage. If you find comfort with massage, we recommend a gentle “sweeping” of the breast during feeding rather than aggressive massaging.
- Over the counter Sunflower (not soy) lecithin supplements have been shown to help with recurrent plugged ducts. We recommend taking 1-2 capsules (one capsule is typically 1200mg) twice a day with food. Please inform your healthcare provider before starting any supplements.
Symptoms of mastitis:
- A plugged duct may be present (an area of the breast that feels firm)
- Localized area of breast redness and/or warmth
- Breast pain (either localized to one area or generalized throughout the breast)
- Breast swelling
- Fever, chills, or flu like symptoms can indicate a bacterial infection. Please contact our clinic/your healthcare provider if you have any symptoms associated with infection.
Management of mastitis:
- Breastfeed frequently in response to hunger cues. It is safe to breastfeed with mastitis.
- Breast pumps can overstimulate the breasts. If pumping is a part of your feeding plan, we recommend following up with a lactation consultant to ensure proper breast pump usage.
- Previous recommendations of heat and massage are outdated, as heat can contribute to inflammation and massage can cause tissue damage.
- Take 600mg of Motrin every 6 hours with food to decrease inflammation and discomfort. You can also concurrently take 1000mg of Tylenol every 6 hours with Motrin. Please follow up with your provider if you have any allergies to these medications to discuss alternative options.
- If you are prescribed an antibiotic, please finish the full course. If you are not feeling better after 24-48 hours of antibiotic use, follow up with our clinic/ your healthcare provider.
- We recommend adding a daily source of probiotics (either via supplement or foods that contain probiotics such as yogurt) while on antibiotics.
- Rest when you can and ensure adequate fluid intake
Follow up:
- Assessment and treatment of recurrent plugged ducts should include a visit with a lactation consultant. If you delivered your baby at CPMC, we recommend following up with the lactation consultants at Newborn Connections. Newborn Connections phone number: (415) 600-2229
- If you develop symptoms of mastitis, especially if you are experiencing fever or flu like symptoms, please contact our nurse triage line at (415) 666-1250.
