Recurrent Mastitis or Plugged Ducts

By Kelly Bonyata, BS, IBCLC

Risk factors for recurrent plugged ducts or mastitis

Most mothers do not experience repeated episodes of mastitis or recurrent areas of breast inflammation, but when problems continue to recur it is important to look carefully at possible contributing factors. Recurrent mastitis is often related to inflammation, oversupply, milk stasis, or repeated pressure on breast tissue rather than a literal “plug” that must be forced out.

It is also important to begin treatment early. Mild inflammatory mastitis can often improve quickly with rest, anti-inflammatory measures, and normal milk removal before symptoms become more severe.

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. See Mastitis and Plugged Ducts for more information.

Risk factor: Inadequate treatment of previous mastitis

A major risk factor for recurrent mastitis is incomplete healing from a previous episode. Sometimes inflammation never fully resolves, leaving an area of the breast more vulnerable to future flare-ups.
Delayed treatment, stopping antibiotics too early, or using antibiotics that are not effective against the bacteria involved can contribute to recurrence. However, not all mastitis requires antibiotics. Many cases are primarily inflammatory and improve with supportive care alone.

Contact your healthcare provider promptly if you have:
- fever
- worsening redness
- severe pain
- flu-like symptoms
- symptoms lasting more than 24 hours despite conservative care
Repeated mastitis in the same location should also be evaluated by a healthcare professional to rule out an abscess or other underlying breast condition.

Risk factor: Oversupply and Breast Inflammation

Oversupply is one of the most common causes of recurrent mastitis symptoms. When the breasts are consistently overfull, surrounding tissue can become swollen and inflamed, narrowing the ducts and making milk flow less easily.
Signs of oversupply may include:
- frequent engorgement
- leaking
- forceful letdown
- baby choking or gulping at the breast
- recurrent areas of firmness or tenderness
Trying to “empty” the breast repeatedly by extra pumping can sometimes worsen oversupply and prolong the cycle. In most cases, it is best to nurse responsively and avoid unnecessary pumping.

Risk factor: Pressure on Breast Tissue

Consistent pressure on one area of the breast can interfere with milk flow and contribute to inflammation.
Possible sources of pressure include:
- tight bras
- poorly fitting underwire bras
- heavy bags or purse straps
- sleeping on the stomach
- restrictive clothing
- baby carriers that compress the breast
If mastitis repeatedly occurs in the same area, consider whether something is placing pressure on that part of the breast.

Risk factor: Mother’s overall health

- Have you been very tired or busy, worried or stressed? Many times mothers who have recurring bouts of mastitis are not getting enough rest or are trying to do too much. Mastitis is often the body’s way of telling Mom to “slow down.”
- Have you been ill? Might you be anemic? Lowered resistance to infection or anemia can cause or contribute to recurrent plugged ducts. A blood test for anemia is a good idea when there is a history of repeated mastitis. Increasing foods containing natural sources of iron (or supplemental vitamins with iron) and a Vitamin C supplement may be helpful.
- Are bouts associated with hormonal changes (ovulation or menstruation)?
- Do you have food allergies? According to La Leche League’s Breastfeeding Answer Book, food allergies occasionally result in plugged ducts that occur either premenstrually or before ovulation:

In her book Breastfeeding Matters, Maureen Minchin theorizes that if a mom has allergies, recurring mastitis/plugged ducts might be caused by the “complex immune responses” that occur when she is exposed to an allergen. In a group of food-intolerant women, Minchin observed that their plugged ducts, “which rarely progressed to overt infection and which often recurred either premenstrually or before ovulation,” were “often accompanied by other symptoms of allergy intolerance.”

Do you smoke? Smoking can lower your resistance to infections.

Risk factor: Mother’s diet

Are you eating regularly, and eating plenty of fresh food and vegetables? This will help to increase your resistance to infection.
Are you drinking to satisfy thirst? Lack of sufficient fluids can contribute to plugged ducts. Make sure you are drinking something each time you sit down to nurse or pump.
Too much saturated fat in the diet can be a problem. Reduce animal fats / limit your fat to polyunsaturated fats and take one tablespoon of lecithin (a dietary supplement available at most pharmacies, health foods stores, etc.) Adding lecithin to the diets of moms with recurrent plugged ducts has been shown to be effective.
There is growing evidence that certain probiotic strains may help reduce recurrent bacterial mastitis in some mothers.
Either too much salt or too little salt in the diet has been linked to this problem.

Risk factor: Baby’s health

Has your baby been ill? Occasionally, baby can have the bacteria in the back of his throat and be reinfecting mom with mastitis. This can be determined by swabbing the baby’s throat. If the culture is positive, then baby should be treated along with mom. A culture of your milk can also help your health care provider better determine the best treatment (antibiotic-wise).

Supportive Care for recurrent plugged ducts or mastitis

Current treatment focuses on reducing inflammation while maintaining normal milk flow.

Helpful measures may include:

continuing to nurse normally
avoiding attempts to completely “empty” the breast
rest and hydration
cold packs or ice between feedings
anti-inflammatory medications such as ibuprofen (if medically appropriate)
wearing a supportive but non-restrictive bra

Gentle lymphatic-style massage may help reduce swelling. This involves very light sweeping motions toward the armpit or collarbone. Deep massage or forceful attempts to break up “plugs” are not recommended, since they may worsen inflammation and tissue damage.