Stop massaging and over pumping - effectively treating blocked ducts, mastitis and nipple blebs

In the past couple of years,  there have been modifications to the recommendations in treating blocked ducts, blebs and mastitis. These new recommendations are based on the current evidence-based understanding of the anatomy of breast tissue and how lactating breasts function.

It is now understood that blocked ducts, mastitis and blebs are primarily caused by inflammation (swelling), edema (extra fluid), and dysbiosis (an imbalance of  natural microorganisms in the breast). They may also be exacerbated by some outdated recommendations that continue to be recommended. Below is an outline of each condition, with the most up to date recommendations for treatment. 

Blocked Ducts

The term blocked duct, is actually a misnomer. As the number of ducts in a breast are vast and interweaving, it is not physiological or anatomically possible for a single duct to have a “plug”. 

Most often, when people have blocked ducts, they are experiencing inflammation of the milk ducts. This can manifest as pain or tenderness, sometimes alongside more “lumpy” or “hard” feelings of the breast tissue. 

Treatment:

• Avoid deep massage. Deep massage of already inflamed tissue, can make the tissue  more inflamed and in extreme cases, cause damage. Gentle massage and lymphatic drainage techniques can be useful.

• Take Advil and Tylenol. This can help with feelings of tenderness or pain, as well as inflammation.

• Use ice. Apply ice for 15 minutes. You can keep applying ice throughout the day. Make sure to wrap ice packs in a tea towel or cloth, so as not to damage the skin.

• Avoid over pumping/feeding. Adding in extra feeds or pumping sessions, will remove more milk from the body, which then signals, “make more milk!” This can temporarily relieve discomfort, but ultimately, increase the inflammation. 

• Sunflower lecithin. Some research (although limited), suggests that taking lecithin can help with the viscosity or thickness of milk, helping it flow more efficiently. Sunflower lecithin is generally preferred over soy lecithin, as only sunflower has been studied. Plus, soy is a food allergen that some people may want to avoid.

• Therapeutic ultrasound. Limited research supports the use of therapeutic ultrasound, to help with persistent blocked ducts. This is currently offered by some physiotherapists. 

Blebs 

Blebs occur on the face of the nipple. They often appear as white mark or blister, over a nipple pore. There can be pain at the site of the bleb, sometimes alongside breast tenderness. Most often, blebs are a result of dysbiosis or an imbalance of the natural breast microbiome.

Treatment:

• Avoid tampering with the bleb. Puncturing, scraping or unroofing a bleb can result in greater injury and potentially an infection.

• Consider a topical steroid. For persistent nipple blebs, 0.1% strength Triamcinolone can help remove any bio film (build up) on the face of the nipple. 

• Avoid saline soaks. Salt water can dry out the skin and cause further irritation. 

• Consider probiotics. There is some emerging evidence that the strains l. salivarius and l. fermentum, can support breast health. 

Mastitis

Mastitis presents as redness on an area of the breast that can look streaky and feel painful and warm to the touch. It can also be accompanied by a high fever.  

As with blebs and blocked ducts, mastitis is tied to inflammation or narrowing of the milk ducts and changes to the breast microbiome. An oversupply, pumping beyond a baby’s milk needs, and deep massage of the breasts can make people more susceptible to developing mastitis.

It is now generally understood that mastitis is NOT caused by bacteria entering through cracked or damaged nipples or from changes to breastfeeding sessions (milk stasis). 

It’s also  important to know that mastitis is NOT contagious. Breastfeeding does not have to be discontinued when dealing with mastitis. 

Treatment:
The first line of treatment for mastitis, is the same recommendations for blocked ducts. 

• Antibiotics. If symptoms are not improving within 24 hours, or they are worsening, antibiotics may be necessary. The first line of antibiotics should be Dicloxacillin or Cephalexin 500 mg, 4 times a daily, for 10–14 days. The second line of antibiotics should be Clindamycin 300 mg four times daily for 10–14 days.