Blocked ducts and mastitis

Do you have breast engorgement, blocked ducts or mastitis?

Woman holding a painful breast

The advice has changed as to how we manage blocked ducts or mastitis!

We no longer recommend that you do any of the following:

  • massage the affected area in your breast vigorously, 
  • feed/pump more than normal on the affected side.  

Read on to find out why and what to do instead. 

The science behind the change


Engorgement happens because there is inflammation in the breast. It is normal in the early days for your breasts to feel full and hard as the milk builds up between feeds. However, when you breastfeed or pump, the breast should feel comfortable and soft afterwards. If the breast remains full, hard, hot and painful, then the engorgement is caused by INFLAMMATION, not by milk that hasn’t been removed from the breast.

Blocked ducts

We used to think that a blocked duct was caused by an actual blockage of milk (a build up of milk solids). Now we know that the cause is inflammation. This inflammation causes the duct to NARROW. Think of it like two lanes of traffic merging into one (see the photo below). When the passageway is narrowed, the traffic builds up behind it. Therefore, the goal isn’t to massage or force that build up through the duct. The goal is to widen the duct so that the milk can flow freely again. 

It’s worth bearing in mind that normal breast tissue can feel quite lumpy when you’re breastfeeding – almost like popcorn under the skin! This is not a sign that you have a blocked duct. A blocked duct feels hard and sore, and there is usually some redness on the skin. 

five lanes of traffic merging into two, with a traffic jam


Think of mastitis as the end result when the inflammation isn’t managed effectively. The inflammation gets worse and spreads. If it proceeds unchecked, then you end up with an infection, which requires antibiotics. 

What causes the inflammation? 

There are a few causes. The two main ones are:

1. Suboptimal positioning at the breast, which causes tissue trauma. When your baby is latched on really well, the breast tissue sits comfortably in your baby’s mouth. It isn’t being dragged, pulled or pinched. Your nipple sits far back in your baby’s mouth and the ducts aren’t compressed by little gums, or pushed up against a hard palate. When positioning at the breast is good, the tissue doesn’t get damaged, and inflammation doesn’t happen. Breastfeeding support can help reduce this tissue trauma. 

2. As your breasts get used to making milk, sometimes some of the lactose in your milk can leak out between the cells in the ducts. This is because as the ducts get stretched to accommodate the bigger of volumes of milk, the spaces between the cells grow wider. Lactose then leaks out through these spaces and accumulates in the tissues causing irritation and inflammation. Regular feeding, so that the breasts don’t become too full, will help reduce the risk of the lactose leaking out. 

How to reduce engorgement, blocked ducts and mastitis

Woman gently massaging her breast

The main steps are:

1. Reduce the inflammation in the tissues 

You can apply GENTLE massage to the breast, stroking back towards your armpit. This helps to shift some of that extra fluid back towards the lymphatic system so that it can get drained away. Think of the pressure you’d use when you stroke a cat. No harder than this! If you have a blocked duct, AVOID direct massage on the area that is hard and red. Remember: we’re trying to reduce inflammation, and any friction on this area will increase the inflammation. 

Apply COLD compresses to the area rather than warm. Soak a muslin in ice cold water, or apply an ice pack regularly throughout the day. 

Ibuprofen and paracetamol will help reduce the pain and inflammation; and are safe to take with breastfeeding. (Provided you’re not allergic and you can take them without any issues!) 5-10 g of lecithin daily may also be taken as it helps to emulsify milk and reduce inflammation. (You can get lecithin in most health food shops.)

2. Feed/pump as normal

We don’t want to increase the demand on the breast and signal that it needs to make MORE milk than necessary. Remember, more milk in the breast will mean that there is more potential for inflammation, because the extra milk will put pressure on those spaces between the cells and increase the risk of lactose leaking out into the tissues. 

3. Work on your baby’s positioning at the breast

You can read my article on positioning at the breast. You may also need to ask for face to face help if you’re struggling! If feeding is painful, or your nipple is pinched after a feed, you may benefit from some breastfeeding support, or a breastfeeding consultation with an IBCLC. You can book an assessment with me here

4. Do you need antibiotics? 

Occasionally, when the inflammation isn’t reduced, you may develop an infective mastitis. This is where you feel really unwell, like you have the flu. It’s common to have a fever, and for your breasts to be very painful and red. If this happens, it’s important you contact your GP or other health care provider for antibiotic treatment. You can continue all the other measures suggested here, at the same time as getting treatment for mastitis.  


Webinar presentation: The Mastitis Spectrum: Clinical Application of the New ABM Protocol, attended 28/08/22

Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022 | Breastfeeding Medicine (, accessed 07/11/22



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2023/2024 Rebecca Scott-Pillai