Sometimes, milk doesn’t drain well from your breast and it becomes “clogged.” The result is a firm section of your breast that may be tender to the touch. Some women describe this as a sphere, like a walnut, a golf ball, or even a tennis ball. Other women feel it as a long tube from their chest wall to their nipple. Others may experience a whole section of their breasts that just feels “hard.” This is a plugged milk duct.

Plugged ducts can turn into mastitis if not drained in a timely fashion. If you develop redness and pain at the site of the plug, and/or a fever, and/or flu-like symptoms, follow instructions for mastitis and notify your on-call OB/midwife.

WHAT’S GOING ON?!

When milk doesn’t drain well from the breast and it sits stagnant, a coagulation of milk can form a thin layer, blocking its ability to flow out of the breast (kind of like when you warm up a cup of milk and there is “milk skin” on top). To make matters worse, when milk builds up, your body doesn’t like it, so the tissue in the milk duct swells. So, now you have a lot of milk and a smaller, swollen milk duct. Baby may need a little help to get this out!

When you have a plugged duct you must

1. Move milk

2. Decrease swelling

Move milk

  1. Before breastfeeding/pumping:
    • Five to ten minutes before breastfeeding/pumping, warm the plugged area with a warm compress such as a warm washcloth, a warm rice sock, or a heating pad. A nice hot shower can also be really helpful.
    • For stubborn plugs, try applying five minutes of vibration on and around the plug. If you don’t have a handy vibrator in your bedside table drawer, you can use an electric toothbrush or razor handle.
    • Try Therapeutic Breast Massage and chest opening stretches.
    • Look for signs of blebs or milk blisters. Sometimes there can be a tiny blockage in the tip of your nipple that can prevent milk from draining. This is often accompanied by focused, needle-like pain in the nipple.
  2. During breastfeeding:
    • Continue to apply warmth to the plugged area.
    • Massage downward toward the nipple at the site of the plug. Try also using constant pressure behind the plug on the side of your body.
    • Try to position the baby’s chin at the site of the plug. If that means the baby will be upside down, try laying the baby on the bed or floor and, on hands and knees, dangle your breast in the baby’s mouth so his chin is at the plug. Enlist the help of a friend here to help support the baby! If you can’t make this happen, just try shifting the baby into different positions.
    • If, after breastfeeding, the plug has not decreased in size, try pumping for 10-15 minutes, continuing to use warmth and massage. Pump just the affected breast and experiment with increasing the suction. Try different positions while pumping including dangling your breast. If you have a larger sized flange, try pumping with that. Get creative here, but don’t hurt yourself.
    • Take a break. After working on your plug for 30-60 minutes, stop. It is really easy to get trapped in a boob tunnel. Try again in two to three hours.

Note: Warmth and massage moves milk, but it also makes swelling worse, so only use warmth five to ten minutes before and during breastfeeding/pumping. Do not use excess warmth when you are not actively trying to move milk.

Decrease swelling

  1. After and between breastfeeding:
    • Take 600 mg Ibuprofen every six hours around the clock.
    • Apply ice to the plug for 20 minutes on, then 20 minutes off. Don’t put ice directly on your skin. Rather, try using a bag of frozen peas or a frozen ice diaper with one layer of fabric on your skin.

Note:  The plug most likely won’t come out all at once, but decrease in size after a number of breastfeeding sessions. After the plug has softened, it’s okay to stop taking the ibuprofen. Know that your breast may feel tender and bruised (like you were punched in the boob) and that is okay; that is because the plug caused tissue trauma. It is also common for the milk supply in the affected breast to be lower after a plugged duct or mastitis. The baby most often fixes this by nursing more often over the subsequent days.

When to seek help:

  • If your latch still isn’t “quite right” it may be because of your plugged duct. See  your IBCLC.
  • If you are having recurrent plugged ducts (more than three per month), see your IBCLC.
  • If plug stays the same or grows in size over the course of three days, call your OB/midwife.