Sometimes a milk duct leading from the alveoli to the nipple can become blocked, resulting in a tender lump beneath the areola. There may also be a wedge-shaped area of redness extending from the lump back towards the wall of the chest. Unlike mastitis, the pain comes and goes with a blocked duct, and unless the duct is infected, you will not feel sick. If left untreated a blocked duct is likely to become infected, resulting in mastitis, infection, or a breast abscess.

Removing the blockage

Continue to breastfeed on the affected side.

Get the milk out however you can. This is the golden rule of preventing engorgement, blocked ducts and mastitis. Use a breast pump or express by hand if your baby is unwilling to breastfeed. It will be painful to continue to feed or express from the affected breast, but removing the milk is the only way to prevent a blocked duct from making you really sick with mastitis. Generally if a blocked duct is left untreated for more than 18 hours you will get an even more painful breast infection.

Breastfeed on the affected side first

Your baby’s sucking will be the strongest at the beginning of the feed, so you have more chance of dislodging the blockage when your baby starts on the affected breast.

Vary the baby’s position at the breast

Doing this ensures that all of the milk ducts are drained. Be sure that your baby has a good attachment at the breast, so that the sucking will be more efficient. Experiment with different positions.

Massage the affected area

Before each breastfeed, give the affected breast a good massage by kneading it gently from the top of the breast down over the affected area toward the nipple.

Point the baby’s chin to the sore spot

Drain the affected breast better by positioning your baby so that the chin “points” to the area that is sore. For example, thinking if the breast like a clock face; if the lump is around 4 o’clock , position your baby’s chin around this point on the nipple clock. The lower jaw is often most effective at getting milk out of the breast. You may have to get creative with positioning here. I found a nifty trick when I was suffering from recurrent blocked ducts, give it a try.

Lay your baby on its back on your bed. Get yourself positioned on your knees and lower the breast into the baby’s mouth ensuring that the chin is positioned to the affected part of the breast. You may have to be positioned above your baby’s head or at an awkward angle to the side to get the chin in the right position, but its well worth temporary discomfort. You also have the advantage of working with gravity using this method. I’ve found it very effective.

Apply moist hot compresses

Apply the warmest water you can stand without burning yourself for a few minutes before breastfeeding or expressing, or soak the affected breast in warm water or in the shower.

Rest

Lie down and snooze with your baby allowing baby to feed when ever it is willing.

Pressure massage

Try a pressure massage on the area of your breast that is swollen and painful. This may help to loosen the blockage. With pressure massage, you do not actually move your hand over the skin as you would with a normal massage. You simply press more and more firmly with the heel of your hand to move the blockage in the duct down closer to the nipple.

To do pressure massage, start at the edge of the lumpy area closest to your chest wall. Apply pressure to that area with the heel of your hand to the point just before it becomes too painful. Hold the pressure at that level until the pain eases off. Then increase the pressure again, without moving your hand and hold it until the pain eases. Continue to gradually increase pressure at that same site until you are pressing as hard as you can. Then pick your hand up, move it down toward your nipple a little further and repeat the procedure. Continue moving your hand a little closer to the nipple each time and repeat the massage until you get all the way down to the nipple.

You may see the congealed milk come out from an opening in your nipple. Even if the blockage doesn’t actually come out, you will at least have dislodged it and moved it toward the nipple so that when your baby goes to the breast and sucks, it can easily be removed. It is always a good idea to put you baby on the affected breast first, when the sucking will be the strongest.

Preventing recurring blocked ducts

Feed your baby in different positions. This will help you to empty all the milk sinuses and ducts.

Make sure your bra is not too tight. You may find it best to wear a bra with no seams. These can be more expensive but are worth the extra money. Some mothers find that crop tops are a good alternative to a bra for smaller breasts.

Pay attention to anything that may put pressure on the milk ducts. Some women find that sleeping on their side or on their stomach is the cause of recurrent blocked ducts. Sometimes it can be the way you hold your baby when you feed. Sometimes it can be the way the baby holds its arm against the breast. Generally for a recurrent problem like this the cause is something that you are doing regularly, so pay attention for a couple of days and see what you discover.

Mastitis

Mastitis is inflammation of the breast, usually due to a bacterial infection. It is excruciatingly painful and can make you feel very sick very quickly.

Since this is likely to be a bacterial infection and can make you feel very ill and can have far reaching consequences such as surgery and early weaning, I recommend that you consult a trusted and breastfeeding savvy GP to determine whether or not an antibiotic is necessary. Mastitis can become a breast abscess that may require surgical draining, but this can almost always be prevented by quick and proper treatment.

What are the signs of mastitis?

The breast is intensely painful, hot, tender, red, and swollen. Some mothers can pinpoint a definite area of inflammation, while at other times the entire breast is tender.

You will likely feel tired, run down, achy, have chills or fever and you may think you have the flu. Mothers with mastitis will sometimes experience these flu-like symptoms, even before they get a fever or notice breast tenderness.

If you have mastitis you will feel progressively worse, your breasts become more tender, and you will continue to experience fever. If you are experiencing engorgement, a blocked duct or mastitis without infection, you will gradually feel better instead of worse.

You chances of suffering from mastitis are greater if you have recently experienced any of the following: cracked or bleeding nipples, stress or getting run down, missed breastfeeds or longer intervals between breastfeeds.