Treatment of plugged ducts

Milk is produced in the alveoli deep inside the breast. Ducts are the tubes that carry milk from the alveoli to the nipple. Each breast has five to 10 ducts that normally remain open so milk can pass through during breastfeeding.

When milk flow is blocked by thickened milk that has remained in the duct, you may notice an area of engorgement, a small lump or a small area that feels uncomfortable.

Goal is it to soften the blockage and move it out through the nipple using a combination of heat, massage and effective milk removal — breastfeeding, pumping or manual expression.

Causes of plugged ducts

• Infrequent or ineffective milk removal
• Missing a feeding
• Overproduction of milk
• Pressure from an underwire bra

Before feeding

• Warm the area of the breast where the blockage is located for a few minutes. Keep in mind that the temperature should be comfortably hot to avoid damaging the breast tissue. Methods to consider include a warm shower, warm packs, a heating pad or soaking the breast in a bowl of warm water.
• While the breast is warm, massage gently and deeply from behind the blockage toward the nipple. Keep in mind the duct may not run in a straight line toward the nipple.

During feeding

• Breastfeed, pump or hand express frequently, at least every two to three hours. Start on the breast that has the blockage but don't forget to remove milk from the unaffected breast. When breastfeeding on the affected breast, position the baby so his/her chin points to the affected area.
• Breastfeeding, pumping or manual expression needs to be effective in removing milk. If you're having difficulty with position and latch, schedule an appointment with a lactation consultant from HonorHealth's Center for Breastfeeding Support. See below for detailed contact information.
• Continue applying heat and massage during milk removal. You may notice some discomfort during letdown. The area with the blocked duct should feel less full following milk removal.
• Try breast compression around the blockage while breastfeeding. With fingers on one side of the breast and thumb on the other side, gently squeeze and hold until the baby stops swallowing.
• Alternate positioning to improve drainage in all of the ducts. Try breastfeeding with the breast hanging over the baby.
• Try pumping with the breast and flange aimed toward the floor.

Following the feeding

• Apply cold packs for comfort. Place a soft cloth between the cold pack and your breast.
• Rest, consume adequate fluids and eat a healthy diet. When the duct is cleared, you may see stringy, thickened milk. The area where the blockage occurred may be uncomfortable for a few days.