While you are breastfeeding or pumping
you may experience certain breast complications. Most can be prevented or
resolved with frequent and effective removal of the milk either through
breastfeeding or pumping. It is important to be able to recognize these potential
problems and treat them quickly to prevent further complications and a
reduction in milk supply. In this video we will discuss engorgement, plugged milk
ducts and mastitis. Engorgement is when there is swelling
and increased pressure in the breasts due to an accumulation of breast milk
and other fluid. The normal lactating breast is softer and feels comfortable.
The engorged breast feels hard, full and tender. Notice how it is not only milk
that causes the breasts to swell, it is a combination of milk, increased
circulation of blood and other fluid. The symptoms of engorgement include
hard, heavy and tight breasts – the whole breast will feel hard. Some redness and
shine on the skin. Tenderness or pain. And, engorgement usually affects both
breasts. It is common to experience some
engorgement as your milk increases in volume. This typically happens between
day three and five after birth. It can also occur at any time of lactation if
the breast is not emptied for a long period of time. If you’re breastfeeding
engorgement may occur if your baby is not latching or drinking effectively. The
most important strategy for relieving engorgement is emptying your breasts
at least eight times in 24 hours. Sometimes the swelling in the breast
tissue during engorgement can be so severe that it stops milk from flowing.
It is important to treat this swelling as soon as it starts to occur.
Apply cold to your breasts for 20 minutes after breastfeeds or pumping
sessions. If needed take an anti-inflammatory such as ibuprofen for
pain control and to reduce swelling. Lie down and massage breasts towards the
armpits to reduce swelling. Apply heat for a few minutes just before feeding or
pumping to help the milk to flow. If your areola, the dark area around your
nipple, is swollen you can do what is called reverse pressure softening before
feeding or pumping. You do this by placing either the lengths of your
thumbs or the tips of your fingers on the areola and applying pressure for 60
seconds. This helps to soften the areola which makes latching and pumping easier.
It may be helpful to do this while lying down to help with fluid drainage. You can
also refer to the International Breastfeeding Center website for more
information on this technique. If after reverse pressure softening your
areola is still firm and making it difficult for your baby to latch you can
try hand expressing some milk until the areola is soft enough to be compressed.
You can learn more about hand expressing in our video “How to establish and
maintain a breast milk supply” which can be found on the SickKids Breastfeeding
Program website. A plugged milk duct is a blockage caused
by an area in the breast that is not draining well. The symptoms of a plugged
duct include a tender lump or lumpy area in the breast. This is different from
engorgement in that engorgement involves the whole breast being hard and
a plugged duct causes hardness in just one area of the breast. The area may look
red and feel warm. There may be decreased milk flow from the affected breast. You
will usually still feel well overall. A plugged duct can be caused by: a poor
latch; the baby feeding less than usual due to illness; feeds or pump sessions
are missed or shortened; tight, restrictive clothing such as wearing an
underwire bra; sleeping on your tummy or more on one side. Frequent and effective milk removal is
the most important part of treatment. Apply heat. Moist heat may work best.
Massage from behind the lumpy area towards the nipple.
If breastfeeding, massage during the feed and try breastfeeding in positions where
the baby’s chin or nose are pointing towards the affected area.
If pumping, massage while pumping. Try hand expressing after pumping to
fully empty the breast. If needed, take an anti-inflammatory such
as ibuprofen for pain control and to reduce swelling. Ensure you are wearing
the right sized bra. Loosen your bra to prevent compression of the milk ducts. Drink plenty of fluids.
Eat a well-balanced diet and rest when you can.
An untreated plugged duct can lead to mastitis. If symptoms have not resolved
with the suggested treatment please seek medical attention. Mastitis is when there is inflammation
of the breast tissue, sometimes occurring with an infection.
Symptoms of mastitis include: a red area on the breast – there can be red streaks;
breast pain; flu-like symptoms such as fever, chills,
fatigue, general aches and pains; it usually affects only one breast, and you
may have a decreased milk supply on the affected side. Causes or risk factors of mastitis
include inadequate emptying of the breasts caused by infrequent feeding or
pumping, persistent engorgement or plugged duct, a poor latch, restricting
feeding times, an oversupply of milk or rapid weaning. Other causes or risk factors are:
bacteria, often entering through a crack on the nipple; illness in you, or your
baby; stress and fatigue. If symptoms are mild you can treat
conservatively at first. Frequent and effective milk removal is the most
important part of treatment. If breastfeeding, try different positions
including ones where the baby’s chin or nose are pointing towards the affected
area. Breastfeeding should be continued during this time. If your baby refuses
the breast, replace feeds with pumping until your baby returns to the breast. If you have been exclusively pumping it
is important to be pumping a minimum of 8 times a day. Your milk supply may drop
significantly on the affected side even with frequent emptying. Just keep
emptying and it will likely return to normal once the mastitis clears. Place
warm compresses on the affected breast for a few minutes before feeding or
pumping to promote milk flow. Apply cold compresses on the breast after feeding
or pumping for 20 minutes to reduce pain and swelling. Massage the blocked area
during pumping or feeding. If needed, taken anti-inflammatories such as
ibuprofen for pain control and to reduce swelling. Drink plenty of fluids and eat
a well-balanced diet. Rest and reach out for support to decrease stress and
fatigue. If you have a high fever or if symptoms
worsen or do not improve after 24 hours of conservative treatment seek medical
attention immediately from your family doctor or closest emergency department,
as you may need antibiotics or further investigation. There are things you can do to prevent
complications. If your baby is breastfeeding, ensure a good latch for
effective milk removal and feed on-demand at least eight times a day. If
your baby cannot breastfeed and you are pumping – start as early as possible to
prevent complications, make sure you are using the right sized flange and pump
settings, and remember to empty the breasts frequently, at least eight times
a day. It is important to treat breast complications as soon as they arise. It
is vital to continue breastfeeding or pumping throughout these complications. Hand hygiene is very important. Wash your
hands frequently, especially if you have a crack on your nipple or breast. Clean
and sterilize your pump kits according to manufacturer instructions. Change
breast pads frequently when wet, at least once a day. Engorgement, plugged milk ducts and
mastitis can be a progression from inadequate milk removal. You can prevent
this progression by treating these conditions as soon as you have symptoms.
General treatment principles are the same for all three. Frequent and
effective milk removal, pain relief, breast massage, heat and cold application,
seeking support from a lactation consultant. Seeking help early will help you reach
your feeding goals and prevent complications.
All of these breast complications are associated with milk not being
effectively removed from the breast. It is strongly recommended that you see a
lactation consultant as soon as difficulties arise to ensure your baby
is feeding effectively or for a pumping assessment. You can also seek help from: your family
doctor, obstetrician or midwife; a walk-in clinic; Telehealth Ontario’s
breastfeeding line; the emergency department, if you have mastitis.