Milk Expression for Plugged Ducts, Engorgement, and Mastitis

This is the second in a series on how to treat your engorged, plugged, or mastitic breasts! I highly recommend starting with the post on breast massage! Just as those recommendations have changed over the last several years, so have recommendations for pumping and nursing.

The biggest change is that we no longer say to empty the affected breast as often as possible. That old recommendation can actually lead to more lymph (the fluid that ends up squeezing your ducts and making it more difficult to get milk out), and to an oversupply of milk (which can keep these problems going!).

Instead, we generally recommend you empty the breasts as normal (which should be every 2-3 hours, or 8-12 times/day). So if nursing was generally going well, keep nursing. If you were exclusively pumping, keep up your pump schedule. If you were doing a combination, keep going! Just don't increase your pumping or nursing for the purpose of "removing a clog."

If you are pumping, make sure you are doing hands-on pumping with lots of massage, hand expression, and other compression and skin-on-skin. The challenge with pumping is that it is only suction - which can draw in more lymph fluid. Babies use suction and compression to draw out milk. Another concern with pumping is whether your flanges fit correctly - too big or too small, and this might be the source of your pain, engorgement, plugs, etc.

Don't change anything...unless it was already a problem

If nursing isn't going well, pumping was already hurting, or you are not sure what caused your breast pain, something needs to be changed. If you are so engorged and painful that you are unable to nurse your baby or pump as you did before, you may need some additional strategies to get yourself feeling better and to get your baby fed. Consider consulting with a lactation professional to get (and keep!) yourself feeling better and on track to meet your lactation goals.

In the US, you can find a Board Certified Lactation Consultant (IBCLC) using USLCA's directory, internationally there is ILCA's directory If you already have someone in mind and want to know if they hold this highest clinical lactation credential, you can search here.

A Brief Summary

Keep emptying your breasts as you have been. Constant pumping and nursing is not recommended. Increased pumping and nursing is only the answer if you were previously emptying your breasts too infrequently (fewer than 8 times a day, or about every 2-3 hours). If you are pumping, ensure your flanges fit well, and use massage and other hands-on pumping techniques. I strongly recommend you reach out to a lactation professional to make a plan that is specific to you and takes your history and your goals into account.

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.