Massage for Plugged Ducts, Engorgement, and Mastitis

What if I told you that massage for painful breasts should feel good and relaxing? What if I told you that you should get some relief in about 15-20 minutes? Probably the number one thing I have been educating new parents on lately is how to best massage their breasts. There is so much outdated information out there on how to care for engorged breasts and plugged ducts that I'm going to do a multi-part series on this!

In the past, we lactation professionals have advised parents to firmly massage tender breasts toward their nipple, with a goal of moving milk out of the breast. Recently, various imaging and studies have shown that this is completely backwards.

While, yes, there is probably milk "backed up" in your ducts to some extent, the current research says that the milk is getting stuck because the ducts are being squeezed by lymph fluid. Think about slowly squeezing a straw, and eventually closing it entirely. That's what lymph fluid is doing to your milk ducts! Plus, all that extra fluid in your breasts is probably making your skin feel tight, it's backing up into your armpit, and it might even be swelling your breast all the way up to your collarbone! Some spots may feel firmer and more painful than others. The effect can range anywhere from uncomfortable to unbearable; from heaviness and tightness to a feeling that your breast might literally explode, and the thought of nursing your baby or pumping your breasts is like torture. THE SOONER YOU CAN TREAT YOURSELF RIGHT, THE BETTER! Therapeutic Breast Massage in Lactation:

The goal of therapeutic massage in lactation is to get the lymph out of your breast so the milk can flow freely. Also, getting that lymph out quickly relieves a lot of pain and discomfort! So how do you do it?

The first thing to know is that lymph can't leave through your nipple. You need to get it to a lymph node, which will eventually get that extra fluid into your blood stream. So where do we want to get that lymph to? Your armpit. You know, the exact opposite direction we used to tell you to massage toward! So this means all your massaging strokes should eventually go to your armpit.

The second thing you need to know is that moving lymph fluid is a pretty superficial and light process. You do not need to do a deep massage. In fact, the way I describe it is to massage with the pressure you would use to pet a cat. So it's not feather light, but it is not aggressive at all. Your cat (and your breasts) should want more! You can use long strokes over the entire breast or focus on the most uncomfortable areas. If that area is under your breast, or on the inside/in between your breasts, you'll want to make those long cat-petting strokes over the area moving up and out, and then do some strokes toward your armpit.

There are other kinds of massage you can do - like gentle pats with all of your fingertips together, or "raindrop" taps with individual fingertips. Some protocols recommend preparing your lymphatic system with circular massage to the armpit and collarbone areas. I keep it pretty simple and just teach the long cat-petting strokes because it gets such good results and is easy to remember and to do. Very often when I provide this massage, milk starts flowing within a few minutes. Clients visibly relax very quickly and usually feel much better after about 15 minutes. I highly recommend doing the massage before pumping or nursing, and any other time you're feeling uncomfortable. You can also do it during feeding and pumping!

I also encourage partners to help with this really important job. (I have lost count of how many couples have enjoyed the flirtation and humor of a request to "pet my cat.")

A brief summary:

Make long strokes over the area as if you were petting a cat. Think about ending those strokes at your armpit. You can think of the cat as being curled up around your breast, but the tail is always in your armpit! Stroke from "head to tail" just as you would a cat.

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.