If you’ve ever dealt with a client in fear of a painful lump in their breast, believing they have an invasive procedure, you know it all too well. And if you’ve recently read ABM Clinical Protocol #36 and wondered how to explain what’s going on, you’re in good company.
The growing number of breast milk donors is struggling right now: Clients and partners still use the term “connectivity” loosely. But the 2022 protocol says it is not physically or biologically possible for one channel to be blocked by a milky milk plug.
So what do you do with it? And most importantly, what do you do to a parent who is sitting in front of you, feeling pain?
What Has Changed and Why
The most common picture of the sticky process was straightforward: Milk would stick to one of the ducts, become blocked, and cause a painful cyst. The fix was to massage vigorously and spray frequently to get through it. It made sense.
But the body does not agree with it. Breast veins are innumerable and connected, not small tubes that can be blocked and removed.
The ABM protocol reflects this, and also classifies what we call “blocked ducts” as inflammatory mastitis at the lower, lower end of the breast inflammation spectrum.
What does this mean clinically? It means that the painful, hard, wedge-shaped area that the parent is talking about is actually a cyst, not a plug that is sitting in the passageway waiting to be released.
This is not a little different, because the old method of treatment, which aims to remove it (massage, heat, frequent spraying) can increase the inflammation instead of solving it.
That said, the science here is still moving forward, and clinical practice sometimes takes a back seat to the theory.
Dr. Melody Jackson, whose LER study on breast inflammation informs this series, says that although the principles of the process are clear, she has seen what appears to be a lot of milk described in these sections in her practice.
The current medical picture: We may not have complete agreement on the exact formula, but we have a pretty good guide on what helps and what harms.
How This Relates to All Spectrums
Breast inflammation itself, no matter what we call it, is on the first end of the spectrum The disease is caused by inflammation of mastitis, bacterial mastitis, and abscess. That placement is clinically important.
It means that early, gentle action can prevent escalation. It also means that the instinct to reach for aggressive drains or antibiotics at the first presentation is always wrong.
Most of these manifestations will be resolved with regular care. The goal is to reduce inflammation, not fight it.
what to do
- Use anti-inflammatory medications early. Ibuprofen is safe for breastfeeding and very effective. It regulates the inflammatory process directly, rather than just managing the pain, and can prevent mild inflammation from progressing.
- Continue to feed gently, carefully. Getting rid of milk is important, but the key word is gentle. Continuing to breastfeed from the affected side helps maintain mobility without disrupting the system. Short, easy meals are the goal, not marathon sessions aimed at “getting rid” of the dough.
- Apply cold compresses to relieve pain. It solves the inflammatory part directly. Cold is now preferred over heat, which can cause nerve damage.
- Try gentle lymphatic channels. Light strokes that move fluid to the axilla (feather light, not deep tissue) can help reduce interstitial edema without the tissue damage that massage can cause. The evidence base is limited, but the risk of harm is low.
- Confirm and teach. These episodes are scary for parents, especially when they hear the words “plugged duct” and think that something is fixed. Revamping the situation as a recurring inflammation that responds well to minimal maintenance can reduce fearful behavior such as aggressive self-stroking or aggressive pumping.
- Follow along, sooner than you think. Early breast swelling can improve quickly. Medical cases of Dr. Jackson suggests that 48 hours can be the difference between a clearing phase and a progressive infection. A well-followed plan with a short window if things get worse is important.
What to Stop Doing
- Stop accepting aggressive massages. This is perhaps the most important change. Massaging deep, swollen chest or breast tissue can cause damage, increase edema, and increase inflammation. This is one of the things that is said to be very helpful for clients who go from early inflammation to phlegmon or abscess. Wanting to “fix” is understandable, but it hurts.
- Stop pumping frequently. Telling a parent to pump every hour to clear congestion is old advice, and in parents with a normal or generous diet, it can drive hyperlactation, one of the causes of breast swelling. Deleting information is not always a good idea. Accountability, free removal is what the evidence supports.
- Stop lead and heat. Warm compresses and warm showers feel good and refreshing, but prolonged heat can aggravate nerve compression and edema. Cold compresses are now more prone to swelling.
Down Under
Early treatment, a little attention to the swelling of the breast itself can prevent it from escalating to dangerous manifestations. When parents receive the right guidance, and when providers resist the influence of aggressive intervention, most of these situations end quickly.
The term may be changing, but the medical treatment options are exactly the same as they always have been.
Ready to Learn More?
This blog is based on Dr. Melody Jackson of LER, Traveling Breast Inflammation: Engorgement, Mastitis, and the Evolving Science of Care. For a critical, critical review of the current evidence, his studies are a good next step.
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We have explained all aspects. See also two other articles:
Mastitis Care Has Changed
It’s Not Just Milk: Understanding Engorgement