Plugged Ducts & Mastitis FAQ

Plugged Ducts are a common problem for breastfeeding moms. They can be quite painful and if left untreated, can result in mastitis and absess. Plugged ducts contain cells and other milk components that were shed within the ducts. They are localized in the breast and do not produce systemic symptoms. They may be absorbed by the body, may appear in the milk, or can be removed by the mother.

Treatment starts with trying to find a cause for the plugged duct. Possible causes include poor positioning to remove milk (perhaps holding the baby in an awkward manner), engorgement because of missed feeds or irregular nursing patterns, incomplete removal of milk from the breast, and external pressure on the breast.

Things to Try:
Try a variety of positions for more efficient milk removal.
Nurse the baby with her chin pointed toward the plugged duct.
If you are prone to plugged ducts, try to avoid missing feeds or if a feed is missed, pump instead.
If the baby does not adequately remove milk from the breasts, pump or manually express after feeds.
Nurse long enough on each breast for the baby to remove sufficient milk.
While nursing on the affected side, use massage and heat to encourage drainage. {Use either a heating pad or warm compresses. Gerber has disposable pads expressly for this purpose.}
Nurse more frequently on the affected breast.
Gently roll, pull, and rub the plug down while in a warm shower.
Use moisture to remove any dried secretions that are blocking nipple pores.
Avoid positions that put pressure on one spot for long periods (an example might be always sleeping on one side or always holding the baby one way, or the baby sleeping on the mother's chest.)
Use a larger nursing bra or a bra extender.
Avoid bunching up a sweater or nightgown under the arm during a feed.
Use a nursing bra instead of pulling up a regular bra to nurse in order to avoid pressure on the ducts.

Mastitis

Mastitis is a conditioned characterized by an inflamed area of the breast which becomes red, hot, and tender to the touch. It produces a fever and flu-like symptoms. Most breast infections are located outside the ductwork in the surrounding tissues and not enter the milk, therefore it is reasonably safe for a baby to nurse through an infection. It is caused by a variety of organisms, but Staphylococcus Aureus and Streptococcus are the usual culprits, which are found in most homes and are probably introduced via the baby. Even though the breast produces antibodies, sometimes infection develops in the cells. Mastitis is usually preceded by fatigue and stress. Recurrent mastitis might be caused by anemia or other deficiencies (leading to decreased ability to fight off infection), being treated with the wrong antibiotic, or not being treated with antibiotics long enough. Treatment consists of bed rest for several days, warm, moist compresses to the inflamed area of the breast before and during a feed, and milk removal from the affected breast by allowing the baby to nurse with her chin pointed toward the inflamed area. It is important to feed frequently to cleanse the breast in order to prevent milk stasis. Pump when necessary, but remember the baby is usually much more efficient at milk removal. Other treatments include an antibiotic (Contact your doctor if the breast inflammation has not resolved in a 24-hour period after beginning treatment or if the mother's fever rises above 100.7 degrees.) It is a good idea to start the antibiotic immediately to reduce the severity of the infection; this also protects milk production. An anti-inflammatory medication (such as ibuprofen) can often be used to relieve pain in the area. Some people have had good results with applying crushed cabbage leaves to the breast between feeds. Also, you can try briefly soaking the breasts in a saline solution (1/4 tsp of salt in 8 oz. of water) after feeding and allowing them to air dry.

If a breast infection is not treated in the correct manner (or if it was unresponsive to treatment), it can lead to breast abscess. Symptoms are often less severe than mastitis because the abscess is walled off. It can be a serious health hazard and should be treated immediately by a physician. It will usually need to be lanced and allowed to drain and the infection will be treated with additional medication. If this happens, the mother can continue to nurse on the unaffected breast depending on the location of the abscess, the pain associated with it, and the medication she has been prescribed. If she is unable to nurse, it is important to express milk from the affected breast or wean the baby from that breast. It would be a good idea to get opinions from a certified lactation consultant at this point and the healthcare provider. An abscess, unlike other sore spots or swellings on the breast, is a mass that has been described as "boggy" or "putty-like" when palpated. Diagnosis is often made after an ultrasound of the area.

Disclaimer:I am not a physician and the content on this page is not intended to diagnose or treat. It is merely information I have picked up and would like to share with others. Please see a physician or certified Lactation Consultant for help with specific problems.

{Information Taken from Pocket Guide for Couseling the Nursing Mother. Shinskie, Lauwers. Jones & Bartlett Publishers. 2002.}

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