By Dr. Nancy Brent

Nursing mothers may occasionally develop hard, sore areas in the breasts. These are often areas of obstructed milk flow, which are not draining. The area may be hard and painful. Generally, since it is localized, no other symptoms are present, such as aches and chills. If the area is red, feels warm to touch or you feel ill with a fever and flu-like symptoms, this may be a sign of a breast infection. You should immediately call your doctor, as this will probably not respond to the below recommendations without antibiotics.

The most common reason for plugged ducts is going longer stretches without emptying the breasts, as when baby sleeps longer than usual. Being separated from your baby upon  returning to work or school can also prompt a plug to occur. Nipple shields and breast pumping can also contribute to plugged ducts, as breast milk may not be adequately removed. Other causes of plugged ducts can be oversupply and undue pressure on the breast from a tight fitting or underwire bra.

Managing plugged ducts

In order to relieve the plug, it’s important to get the milk flowing again. Try to breastfeed as often as possible and minimize pumping. Pumping can stimulate milk production without adequately removing the milk. Moist heat applied to the plug can help. Avoid deep or excessive massage, as this can increase inflammation in the breast. During the feeding, gently massage the tender area with very light strokes- like petting a cat. You may find this handout useful: Lymphatic Breast Massage In between feedings, use warm compresses to the area like the rice sock described below. Try to correct the underlying cause of the plugged duct. For example, if you are back to work, try to keep your pumping schedule the same as the baby’s feeding schedule.

Moist heat or Rice bag

Applying a warm, wet washcloth or homemade rice bag can provide a convenient source of moist heat for treating plugged ducts. A rice sock can be made by filling a clean sock with 1 cup of uncooked rice. Close the sock by tying with a string, a rubber band or stitching. Place the sock in the microwave with ½ cup of water beside it. The water and the rice should never touch. Heat the rice bag for about one minute. Test to see if the heat is comfortable. Tuck the rice bag into your bra or hold it on the breast over the area that is clogged. It should be as warm as possible, while still being comfortable. Leave the sock on the breast or in your bra for 10 minutes before breastfeeding or use it over the castor oil pack.

Oral Lecithin

Persistent plugged ducts may respond to oral sunflower lecithin. While the mechanism for how this works is not clear, it has been suggested that lecithin acts to emulsify breast milk. A typical dosage for plugged ducts is 1200 mg of lecithin, 3-4 times per day. The dosage can be reduced, and then discontinued once plugged ducts cease to recur.

Other Therapies

Gentle lymphatic breast massage, as mentioned above and therapeutic ultrasound may also help with plugged ducts. Both can reduce inflammation and swelling.

However plugged ducts are treated, if they do not resolve within several days following any of the above measures, it is very important to follow up with your medical provider. They can evaluate the breast to rule out any other potentially serious conditions. 

Dr. Nancy Brent is the former Medical Director of the Breastfeeding Center of Pittsburgh.