Plugged ducts don’t exist. Yes, I said what I said. And I will keep spreading this message as loudly and as often as I can. I can practically hear every parent who has ever suffered from the pain of a “plugged duct” screaming at me. Let me explain. Breastfeeding lore is full of facts, partial truths, and outright tall tales that I call booby traps. Separating fact from fiction can be hard, but we’ve got this. As a breastfeeding medicine physician, my job is to help you figure out what advice to listen to and what advice to ignore.
TRUTH: Many lactating parents develop painful, swollen, firm lumps in their breast tissue. Sometimes, these lumps get so big it seems half the breast is involved! This is real and super scary and frustrating as a parent. Especially because usually the milk from that breast significantly decreases when it happens. Parents are in pain, worried they will lose their milk supply and have heard dozens of horror stories about plugs turning into breast infections like mastitis or an abscess.
TRUTH: Milk is made deeper in the breast tissue, then when needed, flows down pipes called milk ducts until it reaches the nipple and comes out of the breast.
FALSE: We have long assumed that milk ducts are a decent size and travel in a relatively direct, straight path to the nipple. So we thought the painful lumps we noticed must be an actual clog INSIDE the milk duct pipe that was blocking the milk from coming out. And if you believe this is due to a clogged pipe, how would you attack it to get rid of that pesky clog??
BAD IDEA #1: Suction the clog out through the nipple
– Increasing how often you pump
– Increasing the suction level and duration of each pump session
– Position baby’s chin to the area of the lump to send maximum suction toward it
– Dangle your breast over the baby while they’re on their back to let gravity help
– Ask a partner to suck out the clog – yes, this happens
BAD IDEA #2: Push the clog out of the nipple by firmly massaging the lumpy area and forcing it down the duct through the nipple. What if this doesn’t work? Well, push harder, of course. I have seen moms come in covered in bruises from this brutal technique. Why would they do this? Well, parents will do just about anything for their baby, so they will follow bad advice if it’s the only advice they’re getting. Sometimes, they even use combs to apply more focused pressure behind the clog and force it out.
BAD IDEA #3: Break the clog up into smaller pieces that can come out more easily. Vibration from an electric toothbrush, breast massager, or ‘anything that vibrates’ has become widespread in lactation advice. And, of course, putting firm pressure with the vibrating device onto the lumpy area must make it more effective.
TRUTH: NOPE. DO NOT do any of those things. Stop the madness. Plugged ducts don’t actually exist! So, none of this will help. It turns out all these outdated measures may not just be unhelpful at treating the underlying problem. They often actually backfire and make the blocked milk flow WORSE! As a breastfeeding medicine colleague of mine, Dr. Katrina Mitchell, says: “If it doesn’t make sense, stop doing it!!”
It turns out all these outdated measures may not just be unhelpful at treating the underlying problem…they often actually backfire and make the blocked milk flow WORSE!
TRUTH BOMB: Your milk ducts are NOT large pipes that travel in a straight path from the milk-making tissue toward the nipple. They are actually tiny, often microscopic, and are intricately interlaced throughout the delicate breast tissue. There is no way for a lump big enough for you to feel to form in such a tiny duct and then block all the many paths of milk flow out. This changes everything – a total paradigm shift.
Yes, I know. MIND BLOWN. Mine, too, when I first learned this. Why did it take so long to figure this out? Well, lactation consultants and breastfeeding medicine physicians don’t usually get to see inside actual milk-making breast tissue. My friend Dr. Mitchell, though, does this every single day. She is a breastfeeding medicine physician and a breast surgeon. She showed me actual lactating breast tissue from the inside out – even when the breast was ‘full’ of milk, you could hardly see any of the ducts because they were so teeny!!
MORE TRUTH: Plugged ducts don’t exist. There is no blockage from the inside of the milk duct. And the breast tissue and interlacing milk ducts weaving through it are delicate. Instead of helping move a nonexistent plug inside a milk duct, actually the usual firm massage, vibration, and suction backfires and makes things worse! Those techniques cause trauma to the vulnerable tissue and ducts, causing swelling and inflammation of the breast tissue AROUND the milk ducts. THIS is the actual issue – inflammation and swelling around the milk duct puts external pressure on the ducts, which compresses and collapses them. Then the milk gets blocked up behind that narrowed area of the pipe, causing pain and the lump you can often feel.
Same outcome – milk flow decreases, and a painful lump occurs in the breast. But totally different root cause. It is not a plug inside the pipe that starts the problem. It is actually inflammation leading to pressure coming from outside the pipe (and often inflammation of the actual pipe walls themselves) causing the issue. So, the answer lies in decreasing breast tissue swelling and inflammation.
What SHOULD you do for painful lumps that are stopping milk flow in your breast? I’m glad you asked!
1. Gentle lymphatic drainage techniques – this allows for swelling to decrease in the breast. It seems impossible that it would actually help, as it’s so gentle you’re barely touching the breast. This video shows how easy it is to learn this method. I was skeptical at first, too. But this one technique is like magic. It can decrease the lump and pain without even getting a single drop of milk out! As it decreases the swelling, it allows the duct opening to widen again and allow milk through. How often should you do this? At least 5-20 minutes before every pump or nursing session, and sometimes every hour between sessions for the first day or so. There is no such thing as too much – as long as you aren’t using too much pressure.
2. Cold compresses – this decreases inflammation. Don’t put ice directly on the breast, and don’t leave it on for more than 5-10 minutes at a time. Sometimes warmth to the breast just before nursing can help letdown, but I often find it isn’t even necessary with the rest of this treatment plan.
3. Don’t over-pump. Remove milk from your breast like usual, but don’t try to increase supply and increase pump settings. Don’t pump more frequently and for longer than needed. This will actually increase inflammation and damage to the milk ducts. And it will tell your breasts to make more and more milk, called hyperlactation or oversupply. Hyperlactation just leads to more inflammation – it is a vicious cycle.
4. Anti-inflammatory medicine – ibuprofen and other “NSAIDs” can help decrease inflammation when dosed properly. Tylenol can also help with discomfort. Please check with your physician to be sure that these medicines are safe for you.
5. Rest, relax, and stop overdoing things. You know you have been trying to do too much. All new parents are. Sit down, sip on some water, eat nourishing food, and clear your schedule. Breathe.
If things aren’t improving in a day or two, if you develop fever or worsening pain, or if you are repeatedly getting these compressed ducts, then see a breastfeeding medicine physician. We are experts in treating the painful area AND then sorting out the underlying root problem leading to the issue. The Lactmap at IABLE is one of my favorite resources to find lactation physicians and other lactation professionals near you.
I wish you all the best on your breast or chest-feeding journey. Be kind to yourself, and be kind to your breasts.
