Ductal narrowing is the term used to describe clogged milk ducts. Research has shown it is not physically possible for a single duct in the breast to become blocked with a milk “plug”.¹ It is more accurate to say the ducts become inflamed, and then narrow. You may feel relief when breastfeeding because when milk is removed, swelling decreases. However, repeated breastfeeding or pumping to relieve the “clogged duct” may increase the risk of over production and increase inflammation which can lead to more ductal narrowing. If ductal narrowing is worsened by milk production overstimulation, inflammatory mastitis can develop, and bacterial mastitis may follow (often requiring antibiotics to resolve).¹

What You Can Do About Ductal Narrowing:^1,2

• Feed your baby on demand based on their hunger cues 
  • Excessive pumping and breast stimulation can lead to milk oversupply and is a major risk factor for worsening inflammation and ductal narrowing.
• Decrease breast pump usage
  • Breast pumps in addition to pumping can overstimulate breast milk production. Ideally, breastfeeding will keep your supply in line with your baby’s needs without creating an oversupply. Try to use a pump only when you are separated from your baby, and/or if you need to use a pump because of a medical reason. If you are exclusively pumping, only pump enough to meet your baby’s needs.
• Try to avoid the use of nipple shields 
  • Nipple shields have been shown to contribute to inadequate milk removal.
• Wear a supportive and comfortable bra
  •  This is the time to buy a new, comfortable, well-fitted breastfeeding bra.
• Avoid deep tissue massage of your breast
  • Deep tissue massage can cause increased inflammation. Manual lymphatic drainage (see Figure 1) with light sweeping of the skin from the nipple towards the clavicle, rather than deep tissue massage, may be beneficial to help resolve ductal narrowing.
• Avoid saline soaks, castor oil, and other topical products
  • These products may cause tissue damage especially if combined with deep tissue massage.
• Avoid applying heat to your breasts
  • Heat may cause more inflammation and worsen symptoms of ductal narrowing. Heat may also provide you with some comfort, so just be mindful with use.
• Treat any nipple blebs
  • A nipple bleb is when inflamed duct cells move to the surface of the nipple. Try not scratch off or remove the bleb. Oral sunflower or soy lecithin (5-10 grams a day) and/or a steroid cream prescribed from your healthcare provider may reduce inflammation. It is still safe for you to breastfeed with a nipple bleb.
• Treat milk oversupply
  • Oversupply is defined as the production of breast milk in excess of the volume required for your baby to grow. Behavioral changes with the breastfeeding process, herbal therapies, and prescription medications have been used to treat milk oversupply with varying degrees of success. 
• Consider taking a probiotic
  •  Some research suggests that probiotics (promote the growth of helpful bacteria) may assist with the mastitis spectrum which includes ductal narrowing. The probiotic should contain Limosilactobacillus fermentum or Ligilactobacillus salivarius.

Figure 1: Lymphatic Drainage Technique¹

Figure 2: Nipple Bleb Examples¹

What If I Have Questions?

If you are interested in learning more, these Aeroflow classes expand on some of the topics discussed above:

• Ultimate Breastfeeding Prep
• Lactation Q&A

Want More Info?

For a directory of Aeroflow’s other Care Guides offering information on pregnancy, baby care, and more, browse our comprehensive list of titles:

References