Breast massage – the new ‘no’ for engorgement and mastitis

In 2022 the Academy of Breastfeeding Medicine Brought out a new protocol, Clinical Protocol #36, on managing the mastitis spectrum. This protocol has replaced previous ones and completely changed how we look at engorgement, mastitis and other breast tissue complications like breast abscesses and plugged ducts.

Please note that this is part of our series on ‘ The Updated Protocols on Engorgement, Mastitis and Breast Tissue Complications’. Please click here to visit the main article in the series, which will also give you access to all other supportive content.

For as long as we can remember breast massage has been part of managing engorgement and mastitis. This was based on how we saw the anatomy of the breast – milk glands, each with a few smaller ducts that ran into larger ducts opening up on the nipple. With that image in one’s head it makes sense that massage will help milk to drain and should relieve the fullness, right?

New technology brought new understanding of the anatomy of the breast, and we couldn’t have been more wrong. We now know that millions microscopic ducts comes together in only a few larger ducts running out to the nipple. And breast fullness is not due only to milk not flowing, but to inflammation and swelling and blood flow and cells. Read our main feature for a more detailed explanation of both breast anatomy and what happens when things go wrong.

When you massage a breast that is inflamed and congested, you will simply bruise and damage the breast tissue already under so much strain and pressure. And dead cells will become a growing place for bacteria. This may be the cause why inflammatory mastitis becomes bacterial mastitis and eventually a breast abscess.

The best analogy is a bunch of grapes. Each grape represents a milk gland, with its intricate inner workings, and ducts leading to the outside. Massaging these grapes won’t produce grape juice! It will simply turn it into a pulp and a mess.

It is important to realize that 95% of content on the internet and probably as many healthcare professionals are not up to date on new protocols and will still recommend traditional breast massage!!

This doesn’t mean that massage now has no place. Newer massage techniques increase lymphatic drainage which will help to reduce swelling and congestion. It is done on the surrounding tissues, and only very lightly over breast tissue (not the traditional attempt to remove toothpaste from a near-empty tube). Click here for a wonderful hand-out by the website physicianguidetobreastfeeding.org.

Here are a few more methods no longer recommended as a treatment option for engorgement and mastitis:

• Applying heat in the form of compresses, warm showers and warm water soaks. This will simply worsen swelling and inflammation.
• Any form of massage to get rid of plugs and clogs.
• Applying saline soaks or castor oil to the skin – take note though that I personally recommend Heel’s Traumeel Gel or Natura’s Arnica Gel as these are homeopathic, safe in breastfeeding and anti-inflammatory. Simply apply it to the breast (not onto the nipple itself); don’t massage or rub it in.
• Trying to empty the breast through pumping – this often doesn’t empty much and simply stimulates even more supply.
• Using any form of vibrating device like a breast massager, an electric toothbrush or a vibrator.
• Dangling over baby or feeding baby in any other unusual position. Rather just choose a position comfortable to you and baby.
• Using silicone milk collectors to drain the breast – this will once again increase supply and may cause additional swelling.
• Applying cabbage leaves to the breasts – there is no evidence that this will work better than ice packs, and it carries the risk of listeria infections.

Read our article on mastitis for in-detail information on ways to manage engorgement and mastitis.

Read more

https://physicianguidetobreastfeeding.org/mythbusters/breastfeeding-and-massage/

https://llli.org/breastfeeding-info/mastitis/