Ice or Heat? (How to Care for Plugged Ducts, Engorgement, and Mastitis)

This is the third post in a series on caring for yourself with engorgement, plugged ducts, or mastitis. I highly recommend looking over the first two on massage and milk expression. You've probably seen conflicting advice about heat vs ice when you're dealing with painful breasts, and even conflicting advice on which you absolutely need to avoid.

There is a clear winner in studies looking at reducing the inflammation associated with engorgement, plugged ducts, and mastitis. And that winner is: ICE. The evidence tells us that ice or other cold therapy is best for treating inflammation, and heat can feel good but make matters worse.

My advice is to ice after you feed. You can use products meant for breasts, or you can use a bag of frozen peas, or even crushed ice in a ziploc bag. Whatever you use, I recommend some sort of barrier between you and the ice (a t-shirt works well!). The evidence regarding cabbage is mixed as to whether it does more than provide cold therapy, but it may be associated with lowering supply and it does represent a potential listeria risk.

If you feel like heat helps your milk start flowing (letdown), by all means use heat right before you nurse or pump. However, might I recommend some therapeutic breast massage instead?

What else should I do for the inflammation and pain?

My first recommendation is always therapeutic breast massage. It works very quickly at the beginning of the inflammatory processes that take you from engorgement to mastitis. Beyond that, non-steroidal anti-inflammatories (NSAIDs) are great for the inflammation, and acetaminophen (Tylenol) can help with pain. You may already be alternating these two following birth - they will also help with your breast pain!

A brief Summary:

Ice after/between feedings, use therapeutic breast massage or mayyyyybe heat to help you letdown, take an non-steroidal anti-inflammatory (NSAID), and consider alternating the NSAID with acetamenophin (Tylenol).

For more information

The Academy of Breastfeeding Medicine put together a brand new protocol on "The Mastitis Spectrum" in 2022. It is jam-packed with information, but it is not meant to be for parents in the throes of this spectrum. This spectrum ranges from engorgement all the way to abscess. Because there are photos all along the spectrum, and the protocol is written for clinicians and not parents, I do not recommend opening this if you're feeling anxious or overwhelmed.