Tips for lumpy, painful breasts
If you’re experiencing “clogged ducts” or your breasts are engorged, you’re probably in a lot of pain. People often get the advice to massage their breast tissue to “squeeze a plugged milk duct out,” which will make it worse.
Why breast massage can be painful
Lactating breasts have incredibly robust blood supply, lymphatic vessels to drain extra fluid, nerves, connective tissue, and functional glandular tissue. There are millions of innumerable, microscopic interlacing ducts in the breast. My hope is that providers and patients can recognize that any forceful physical manipulation of the breast simply causes MORE tissue swelling.
Squeezing your breast with force can cause worsened tissue swelling, collapse of ducts, and injury to capillaries. The breast is a gland just like the thyroid, pancreas, or adrenal gland. Without question, we know we would injure these glands if we massaged them vigorously or handled them without delicate surgical precision in the operating room.
What exactly is a “clogged milk duct”?
A “plugged duct” is a collection of blood vessels, very full alveoli (the cells that produce and store milk), and tissue swelling, not a discrete “plug” of breastmilk. Even the nipple leading to the orifice surface has countless ductules. The ROOT cause of “plugging” (i.e. often oversupply/hyperlactation or ductal narrowing/inflammation) needs to be explored and treated.
Think of this “plug” as a group of GRAPES.
These “grapes” represent the alveolar cells that make and store milk. If you squeeze the grapes, you bruise them and/or turn them into grape juice.
These are “decorative” grapes I use as an example of what patients are feeling when they have an area that is “plugged.” The alveolar (milk-making and storing cells) are full and juicy. There is not a “plug” of breastmilk.
Should I massage my breasts if I have mastitis?
Traditional recommendations regarding mastitis unfortunately result in worsened symptoms in most patients. For example, women are instructed to breastfeed very frequently or “pump to keep their breast empty” in the setting of mastitis. Unfortunately, this stimulates more blood flow and more congestion in the setting of an already inflamed gland, and it stimulates the breast to produce more milk. Remember that milk is made and stored in alveolar cells, not ducts.
I tell patients to treat their breast like a sprained ankle. You wouldn’t massage a sprained ankle. You wouldn’t massage another gland like a thyroid in the setting of thyroiditis. The breast is no different.
What happens when you massage?
When you massage an early “plug” you can develop a phlegmon (mass-like area with broken capillaries and inflammatory fluid). If massage and pumping or overfeeding continues, the phlegmon coalesces into an abscess.
Think of the progression like this:
#1: Normal grapes
#2: Grapes that got smashed in your grocery bag. It is a mix of skin, grape pulp, and liquid. This is a PHLEGMON.
#3: If you were to continue smashing these grapes and adding more grapes to the mix, you would get more and more liquid and less solid material. This is an ABSCESS.
Three more images below from Sirilak Thavornwattana, Pediatric APN, Thailand of serious bruising caused by massage of the lactating breast:
Lymphatic Massage for the Breast During Pregnancy and Lactation video.
