Clogged Ducts and Mastitis: Why Am I Getting Conflicting Advice?

If you  find yourself with a clogged duct or mastitis and are getting conflicting advice on what to do, you are in the right spot. 

Currently, if you do a quick google search, ask your local online “mom group”, or even call the nurse line at your doctor- you may get outdated advice.  Ice vs. heat, massage vs. rest…. What is the correct answer?

The reason that you are getting so many conflicting answers is because there is an old way of thinking about plugged ducts and a new way.  It used to be understood that a plugged duct was a literal clog of milk that you needed to push or pump out to “unclog” the breast.

The updated research tells us otherwise.  In 2022, the Academy of Breastfeeding Medicine published an updated protocol for mastitis. This protocol categorizes engorgement, “plugged ducts” (blocked ducts is new term) and mastitis under the term “The Mastitis Spectrum”.

The main underlying cause? Inflammation

What is a clogged/blocked milk duct?

A blocked milk duct is part of the mastitis spectrum and is actually inflammation of the milk duct and surrounding tissue. The swelling makes the duct narrow, which slows milk flow and causes that tender lump or fullness. The best way to help clear a blocked duct is to reduce the amount of swelling/ inflammation. A blocked duct can lead to mastitis if inflammation worsens.

What is inflammatory mastitis?

Mastitis is inflammation of the breast tissue (more widespread than a plugged duct). It can lead to infection, if untreated. Signs and symptoms may include: Redness/warmth/pain to breast tissue, chills, fever, fatigue and increased heart rate.

Interventions that can be helpful to resolve blocked ducts and mastitis: 

• Cold compress to area to swollen, tender area

• Anti-inflammatory medications such as ibuprofen (if approved by your doctor)

• Normal feeding or pumping (not extra)

• Gentle lymphatic massage- light brushing backwards towards armpit 

• Breast gymnastics- gentle movement and stretching of the breast

• Choline via diet or supplementation

• Probiotics with strains L. fermentum and L. Salivarius

• Handout from ABM with further information

Please note, this information is not meant to replace guidance from your provider. There is risk of infection when experiencing mastitis and antibiotics may be necessary. Please always call your provider to discuss your symptoms.

What is NOT recommended and can actually increase inflammation and worsen symptoms:

• Deep, painful massage

• Heat to the area

• “Emptying” the breast with extra pumping

• Vibration

What causes mastitis?

The Academy of Breastfeeding Medicine states that “Basic scientific research has demonstrated that multiple factors contribute to the development of mastitis”. So let’s dive into the research and what it says are some underlying causes of mastitis:

• Oversupply (Hyperlactation)
  Too much milk lead to increased pressure. This can narrow ducts and create inflammation
  

• Off balance breast microbiome (termed “mammary dysbiosis”)
  Genetics/epigenetics play a role in the breast microbiome . Things such as antibiotics can shift the breast’s bacterial balance and increase the risk of mastitis.
  

• Genetics/epigenetics
  ABM notes that your genetic makeup and epigenetic factors can affect how your breast tissue responds to inflammation and shapes your milk microbiome.
  Some people are simply more prone to mastitis based on their genetics.

If you need help addressing blocked ducts or mastitis, please reach out! We are Board-Certified Lactation Consultants who can help.

Sources:

Academy of Breastfeeding Medicine ABM protocol #36

physiciansguidetomedicine.org

mayabolman.com