Buay Tia Blog

In 2022, the Academy of Breastfeeding Medicine updated its protocol on The Mastitis Spectrum, and completely changed the world of clogged duct and mastitis.

We used to think that blockage happens because the breast milk is too thick, so we advise breastfeeding moms to apply hot compress. NOW ALL THESE ARE NO LONGER CORRECT!

Latest research has shown that clogged duct is caused by swelling in the breast tissue. Swelling causes the milk ducts to narrow, thus milk is unable to flow out. The number one risk factor for breast tissue swelling, is oversupply. That’s why clogged duct commonly occurs when the breastfeeding mom takes milk-boosting food or supplements, such as fenugreek, lactation cookies, salmon, avocado, and oats.

When the breast swelling becomes more severe, the body starts to recruit more resources to heal itself. That’s when systemic symptoms start to develop, including fever, chills, and body ache. With the presence of these systemic symptoms, the condition is now defined as mastitis.

But mastitis has two different kinds. What is described above is mastitis caused by a severe clogged duct. Mastitis can also be caused by bacterial infection. It doesn’t mean that bacteria have entered the breast from outside. Breastmilk has its own unique flora of bacteria like our gut. It is an essential component of breastmilk. But there are occasions when these bacteria can cause a problem. For example, when the mom’s immunity is low (e.g. from lack of sleep and stress), the bacteria may grow excessively and result in a bacterial infection in the breast. The infection causes pain, redness, and swelling in the breast, as well as systemic symptoms such as fever, body ache, and chills.

That’s two different types of mastitis, and they need to be treated differently. But a lot of cases of mastitis can be a mixture of clogged duct and bacterial infection.

Remember that we are treating swelling in the breast. The lumpiness you feel is partially caused by milk blocked inside, and partially caused by swelling. Swelling cannot be squeezed out from the nipple, because swelling is not IN the duct. Swelling is SURROUNDING the duct. So NO FORCEFUL MASSAGE. If you are making yourself more painful by pressing hard on the breast, you are increasing the swelling inside the breast tissue. Even if you manage to squeeze out some milk, the swelling is still there, and milk will get blocked again once the ducts are refilled.

We treat clogged duct by reducing swelling. Once the swelling is reduced, milk can flow more smoothly. There are two things we can do at home to reduce swelling:

1. Cold compress

The most effective way of applying cold compress is to do it right BEFORE pumping or latching. Grab anything from the freezer (not the fridge, which is not cold enough), wrap it with one layer of wet towel, and apply it on the painful or lumpy area. It should only be applied for 5-10 minutes, and followed by pumping or latching immediately. The symptoms should start to improve after pumping or latching, but it may take several sessions of cold compress before pumping/ latching to completely resolve a clogged duct. Do not be tempted to increase the frequency of pumping or latching, as it may stimulate the breast to produce more and worse the swelling.

2. Anti-inflammatory medication

The latest protocol by the Academy of Breastfeeding Medicine has advocated for the use of anti-inflammatory medication as the first-line medication for clogged duct and mastitis. One common over-the-counter anti-inflammatory medication is Neurofen (ibuprofen). It is breastfeeding-friendly. It works by reducing swelling in the breast tissue, thus milk can flow more smoothly when pumping and latching.

Anti-inflammatory medications work very differently from Panadol, and they should not be used interchangeably. Panadol reduces pain and fever, but does not create any changes in the breast tissue. Therefore, anti-inflammatory medications are more effective solution for clogged duct and mastitis.

Before taking the medication, one should make sure that they are not allergic to this category of medicine, which is known as NSAIDs. If in doubt, consult a pharmacist or doctor.

If you do not have fever, you can try to manage the blockage by yourself by applying cold compress, and taking anti-inflammatory medication. Mild blockages usually resolve within 1-2 days with these measures. Do not expect it to be completely gone after one magical latching or pumping session. This is because part of the lump is caused by swelling in the breast tissue. Swelling takes time to be absorbed back into the body.

If your symptoms are not getting better with the above measures, or you start to develop fever, then it is time to seek help. It can be confusing who to seek help from, as there are masseurs, lactation consultants, GPs, breast surgeons, and physiotherapists all appearing at the different parts of the spectrum.

If you have persistent fever, you need to see a GP to get antibiotics to treat the likely bacterial infection in the breast.

If you need help in reducing the acute symptoms of clogged duct and mastitis, see a physiotherapist (who is trained in lactation) for ultrasound treatment. If you prefer to engage a masseur, make sure you engage someone who use pain-free techniques.

If you would like to discuss measures for prevention of recurrent clogged duct and mastitis, talk to a lactation consultant.

Occasionally when the symptoms are resistant to all measures above, one need to see a breast surgeon who will do an ultrasound scan to look for other pathologies, such as cyst and abscess.