Breast/Chest Problems, A Summary
In summary all of these problems stem from inadequate milk removal. This can result from a shallow latch, not removing milk often enough, or oral issues with the infant. It is extremely important you work with an IBCLC to address the root cause to improve the condition and symptoms.
Plugged or Clogged Ducts:
Definition: An area where the milk is not readily flowing through the breast due to a blockage from a build up of "backed-up" milk. (Essentially a milk traffic jam in the breast/chest!) Often related to a milk bleb (see below for more on milk blebs)
Symptoms: Firm area(s) in breast that feel like a lump, sometimes are wedge shaped. Sometimes there isn't a specific lumpy area, sometimes it is just a generalized area of soreness. The lump, wedge or sore area can appear to move around. There can be an increase in pain during a letdown, often followed by relief of this area after the feed is over. The mother may express fatty milk "strings" from the nipple. Milk output may decrease temporarily. Usually these symptoms come on gradually and only affect one breast, though can affect both.
Causes: Can be from an outside "restriction" such as a seatbelt, tight bra, underwire bra, finger pressure (such as when hand expressing or massaging) etc. When breasts become engorged where the milk gets backed up quicker than your baby can remove it, you can get a plugged or clogged duct. Also this can happen due to "milk stasis" aka when your baby or pump isn't removing the milk all the way for a "complete" feeding (generally a "complete" feeding is considered between 2-4oz unless you have an oversupply and generally need to remove more!). Other causes can include when there is a latch problem, tongue/lip tie, oversupply, hurried or skipped feedings, abrupt weaning. Also can happen when utilizing nipple shield and not pumping adequately to fully remove milk.
How to fix: Get the milk moving! Things that can help include start feeding on affected breast, apply warm, wet compresses before and massage during feed/pump. If feeling very engorged even after feeding can also add ice pack to breast/area afterwards to help shrink swelling. (This will not help the milk move, but it will help the discomfort associated from swelling.) It is also important to address the cause! If it is due to a poor latch, get some help to obtain a deeper latch. If it is likely due to not removing milk effectively when pumping, check out hands-on pumping technique or power pumping to get some more tips! If in process of decreasing number of feedings or meanings, you may need to return to previous feeding/pumping schedule and decrease at a slower rate. And last, but not least: SLEEP! Sleep is extremely important and though not backed by tons of research, 100% of our clients have had a significant decrease in sleep shortly prior to milk bleb or clog development. Though I'm sure it's difficult, use this as an excuse to request help from your partner, family or friends and consider sleep an "ordered" part of your "treatment plan". ;-)
Milk Bleb or Milk Blister:
Definition: The "back-up" of milk associated with plugged ducts visible at the tip of the nipple. There is a blockage of milk within the milk pore.
Symptoms: There will be a visible yellow, white or clear dot on the surface of the nipple. The pain is concentrated to that one area, it often feels like a needle poking or stabbing that area. If the breast is compressed you may see the dot bulge outwards or a string of fatty-looking milk. (Note: This milk is perfectly ok for your infant to ingest!)
Causes: When a very thin piece of skin grows over the pore and the milk isn't able to move readily through. This causes a back-up, which in turn causes the pain and other symptoms. Other causes can be latch, suck or tongue problems, as well as yeast infections (thrush). Yeast can cause white spots on the nipple, but the main difference is yeast is often accompanied by a “burning” pain, that tends to be worse after nursing/pumping. Whereas a plugged duct generally feels better after the breast has been emptied.
How to fix: All applications for fixing plugged ducts will help with this, as well as lowering saturated fat in diet has been linked to lowering instances of milk blisters. Other recommendations are to put a warm, wet compress on the affected nipple to soften the bleb, you can even do an epsom salt soak for that nipple several times daily or as desired (you can do this in your bath, in dangling your breast in a bowl or using a Haakaa/silicone breast pump). Then pump with hands-on massage or utilizing a hospital grade pump to get the milk moving! These generally will resolve within a few days. They can recur, so you can continue the soaking and epsom salt to prevent recurrence. Soft, gentle brushing of nipple's surface with wash cloth. Should not cause pain or be done roughly, but this gentle exfoliation can help clear a current bleb/clog and prevent reoccurrence. Simply brush gently wash when showering with warm water and a wash cloth. There have been recommendations correlating taking Lecithin supplements to prevent chronic milk blisters. B-complex vitamins, evening primrose oil and thyme have all been correlated with milk blister prevention as well. Always consult physician before considering taking any new supplements or dietary changes. After removal of blister, often that pore will be raw or have very small abrasion. See our breast care guidelines for further information for healing.
Definition: When the milk stasis has become too severe and inflammation develops, this is considered mastitis. This can then turn into an infectious process due to the inflammatory response if not resolved. Most common in first 2-3 weeks, but can happen at any time during lactation.
Symptoms: If plugged duct symptoms don't resolve, but instead worsen. Often leading to fever (temperature over 100.3, most often over 101.3), chills, "flu-like" symptoms, and even red streaks radiating from affected area. Milk can come out "stringy" or "lumpy" with pus or blood, but is still safe for infant consumption. Sometimes infant's may resist the taste, as this can also taste slightly saltier.
Causes: The same causes as for plugged or blocked ducts, as well as cracked or bleeding nipples. The opening in the skin can be a doorway for bacteria to enter into breast. Hospital stays, stress, milk blebs, plugged ducts, history of mastitis and anemia are all factors increasing risk of mastitis.
How to fix: Bed rest, ideally with baby, and with support for you both. Increase your fluids and make sure to eat nourishing foods. The treatment is essentially the same as with plugged ducts, but much more crucial to be done promptly as can become very serious if not immediately addressed. Frequent and effective feedings with wet heat prior and hands on massage/compression while emptying breast. We need to get that milk moving and address whatever the cause may be. IMPORTANT NOTE: If mastitis symptoms are mild and have been present for less than 24 hours you do not automatically need antibiotics and can generally see improvement with aggressive removal of milk as discussed within this paragraph and protocol. However, if you are feeling acutely ill or it's been greater than 24 hours seek out the assistance of your OB or primary care doctor (as well as your lactation consultant to help identify and address the causative issues)! Acutely ill symptoms include sudden temperature increase, red streaks, infant is under 2 weeks of age, both breasts are affected, you have broken skin and/or blood/pus is present. If you receive antibiotic treatment, it is recommended to also begin a probiotic. Also after antibiotic therapy, if nipples become sore, consider thrush/yeast infection and consult physician to address.
If left untreated for generally days or weeks, mastitis can lead to an abscess where the inflammation definitely advances to infection and tunnels to other areas of the breast/chest tissue. You can see here the tell-tale circular often puss-filled bump. This unequivocally requires medical intervention and wound care. See your OB/GYN immediately! These are very uncommon, but important to know what it looks like! You can and absolutely should continue milk removal if you have an abscess. Some lactating parents feel more comfortable pumping and that is totally ok, but this is not the time to wean or symptoms/infection could worsen!