Clinical Practice Points

Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis

J Hum Lact December 7, 2015  0890334415619439
  1. Ann M. Witt, MD, IBCLC1,2,3
  2. Maya Bolman, BA, BSN, IBCLC1,2
  3. Sheila Kredit3
  4. Anne Vanic, MSN, CPNP, IBCLC1,2
  1. Ann M. Witt, MD, IBCLC, Breastfeeding Medicine of Northeast Ohio, 2054 South Green Road, South Euclid, OH 44121, USA. Email:


Background: Many women in developed countries do not meet their breastfeeding goals and wean early because of breast pain.

Objective: This study aimed to describe clinical response to therapeutic breast massage in lactation (TBML) in the management of engorgement, plugged ducts, and mastitis.

Methods: Breastfeeding women presenting with engorgement, plugged ducts, or mastitis who received TBML as part of their treatment were enrolled (n = 42). Data collected at the initial visit included demographic, history, and exam data pre-TBML and post-TBML. Email surveys sent 2 days, 2 weeks, and 12 weeks following the initial visit assessed pain and breastfeeding complications. A nested case control of engorged mothers (n = 73) was separately enrolled to compare engorgement severity.

Results: Reasons for the visit included engorgement (36%), plugged ducts (67%), and mastitis (29%). Cases, compared to controls, were significantly more likely to have severe engorgement (47% vs 7%, P < .001). Initial mean breast pain level among those receiving TBML was 6.4 out of 10. Following TBML, there was significant improvement in both breast (6.4 vs 2.8, P < .001) and nipple pain (4.6 vs 2.8, P = .013). All women reported immediate improvement in their pain level. At the 12-week survey, 65% found the massage treatment very helpful. The majority of the women with a new episode of mastitis or plugged duct during the study follow-up found the techniques learned during the office visit very helpful for home management of these episodes.

Conclusion: In office, TBML is helpful for the reduction of acute breast pain associated with milk stasis. Mothers find TBML helpful both immediately in-office and for home management of future episodes.