Plugged Ducts

A plugged duct is a hard, often painful, area in the breast that doesn’t soften during feeding.  It may be caused by skipped feedings or uneven breast drainage due to shallow latch, poor positioning, or tight clothing.

Treatments for plugged ducts include

•Cold packs and ibuprofen for reducing pain and swelling between feeds.

•Though cold compresses are most effective, some prefer very warm wet compresses or a warm shower before feeding—try a castor oil compress or dangle breast in a bowl of warm water and use gentle massage and/or hand-expression.

•Gentle massage during nursing—a hand-held massager or electric toothbrush held against the plug may be helpful. The plug is between the firm area and the nipple. The firm area is backed up milk behind the plug. Think of it as detangling hair, starting at the end of the tangle and working your way back.

•Frequent nursing on affected breast—vary nursing positions.

Recurring plugged ducts may be due to uneven breast drainage caused by tongue or lip-tie.  Another common cause is poor positioning.  Often as baby grows, a parent will continue to hold baby in their lap to feed, causing baby to pull the nipple to the side.

Image credit: Mothering Touch on Flickr
Baby pulls nipple to the side when sitting in mom’s lap.

Often, all that is needed is to move baby toward his or her feet, so that the nipple is not pulled to the side.  Pay close attention to latch and positioning, lining up nose to nipple and leading with baby’s chin.  Baby’s chin should touch breast before latching allowing baby’s neck to extend and avoiding a tucked chin.

Some positions that may help with releasing a plugged duct are shown in the following photos.

Image credit: Mothering Touch on Flickr

Image credit: Mothering Touch on Flickr


Unrelieved plugged ducts can lead to mastitis, though mastitis can occur with no noticeable symptoms of plugged ducts.   Other possible causes are skipped feeds, cracked nipples, illness, and over-exertion.  It is important to rest and nurse on the affected breast very frequently when mastitis occurs.  Nursing from an affected breast will not harm the baby.  Untreated mastitis can lead to breast abscess which requires surgical aspiration or drainage.

Symptoms of mastitis include

•Red hard painful breast.


•Flu-like symptoms.

•Only symptom may be deep breast pain that doesn’t resolve.

•Even with fever, mastitis may not be bacterial; inflammation can cause fever and body aches.

Treatments for mastitis include

•Cold compresses between feeds and ibuprofen for pain relief.

•Warm, wet compresses right before feeding, castor oil compress, massage during feeding, rest, and frequent nursing.

Raw garlic—2-4 cloves a day, homeopathic phytolacca, belladona, hepar-sulph.

•There is research suggesting that probiotics may be effective for treating mastitis.

•If not improving in 24 hours or if fever is high, contact health care provider for possible prescription.

•Prescribed antibiotics must be effective against staph.

•Take a probiotic while taking antibiotics and for 2 weeks afterward to avoid thrush!

Another highly effective treatment for both plugged ducts and mastitis is therapeutic breast massage, which involves gentle stroking of breast tissue toward the direction of the armpit, alternating with gentle hand expression. A small amount of olive oil may be used to reduce friction during massage. This technique is described by Maya Bolman.

Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis. J Hum Lact. 2016 Feb;32(1):123-31. doi: 10.1177/0890334415619439. Epub 2015 Dec 7. Witt AM1, Bolman M2, Kredit S3, Vanic A2.

The technique is demonstrated in the following video at 2:50.

© 2012 updated November 2017 Laura Spitzfaden, IBCLC