blocked duct (breast feeding)

Last reviewed 05/2023

Blocked duct, sometimes referred as "Focal breast engorgement", "caked breast" or "plugged duct" is localised stasis of milk which is seen in a part of the breast such as a lobe.

It is thought to be due to solid obstruction but ineffective milk removal may also be a cause (1).

Some common causes of a blocked duct include:

• poor positioning and attachment
• pressure owing to a tight fitting bra or other cause such as sleeping position
• trauma due to rough handling or gripping the breast too tightly during feeding
• scar tissue from surgery or injury (2)

Clinical features of a blocked duct include:

• tender localised lump in one breast often with an overlying redness in the skin
• usually there is no fever and the mother feels well
• there may be particulate matter in expressed breast milk e.g. - white granules (formed from a mixture of casein and other materials hardened by calcium containing salts), fatty or stringy looking material, sometimes brown or greenish (1)

Management is aimed at improving removal of milk and correcting the underlying cause:

• make sure that the mother is advised about the correct position and attachment of the baby
  • some suggest that the babies attach better and drain the breast more effectively when the infants chin is held towards the affected area of the breast
  • tight clothes and holding the breast too near the nipple should be avoided since these may obstruct the flow of the milk (1)
• breastfeeding from the affected breast should be done frequently as long as her infant is willing (3)
• wet heat (e.g. warm compresses or a warm shower) may be helpful (3)
  • although the National Institute for Health and Clinical Excellence advise that warm packs or hot compresses may aggravate swelling if ducts are blocked
• massaging the breast using a firm movement over the lump towards the nipple may help in rapid relief of blocked duct and release of the milk (1,3)
• if there is an associated condition such as white spot on the nipple it can be removed with the use a sterile needle or rubbing with a towel
• explain to the mother that the condition tends to recur and early treatment may avoid progression to mastitis (1)

Reference:

• 1. World Health Organisation (WHO) 2000. Mastitis. Causes and management
• 2. NHS Sheffield 2009. Section 1: Breastfeeding
• 3. World Health Organization (WHO) 2009. Infant and young child feeding. Model chapter for textbooks for medical students and allied health professionals