Treatment of Blocked Mammary Duct
For lactating women with a blocked mammary duct, begin with conservative measures including frequent breastfeeding or pumping, warm compresses, and gentle massage; if symptoms persist beyond 24-48 hours or worsen, therapeutic ultrasound is an effective treatment option that resolves symptoms in an average of 3.3 sessions. 1
Initial Conservative Management
- Continue frequent breastfeeding or pumping from the affected breast, as milk removal is the primary mechanism for clearing the obstruction 1
- Apply warm compresses to the affected area before feeding or pumping to promote milk flow 1
- Perform gentle massage from the blocked area toward the nipple during feeding to help dislodge the obstruction 1
- Ensure proper latch and positioning to optimize milk drainage 1
Therapeutic Ultrasound for Persistent Cases
- Therapeutic ultrasound is a proven treatment for blocked ducts that fail conservative management, with patients receiving between 1-7 treatments (average 3.3 treatments) to achieve symptom resolution 1
- The majority of women treated with ultrasound therapy reported improvements in breastfeeding ability and resolution of presenting symptoms 1
- No adverse reactions have been identified with this treatment approach 1
- This modality can be particularly useful for recurrent blocked ducts, which occurred in 32% of cases in one series 1
When to Escalate Care
- If symptoms progress to include fever, systemic illness, or signs of abscess formation (fluctuant mass, severe erythema, warmth), the condition has likely evolved into mastitis or breast abscess requiring different management 2
- Persistent symptoms despite conservative measures and ultrasound therapy warrant imaging evaluation to rule out underlying pathology 3
Critical Distinction: Blocked Duct vs. Duct Ectasia
The provided evidence primarily addresses duct ectasia (a chronic benign condition of dilated ducts with inflammation) rather than acute blocked ducts in lactating women. These are distinct entities:
- Acute blocked duct in lactation presents as a tender, palpable lump in a breastfeeding woman, typically resolving with conservative measures or ultrasound therapy 1
- Duct ectasia affects primarily non-lactating women (mean age 35-36 years), presents with noncyclical breast pain, nipple discharge from multiple ducts, and is associated with smoking 3, 4, 5
- Duct ectasia requires imaging evaluation (mammography for women ≥40 years, ultrasound for younger women) to exclude malignancy, as pathologic nipple discharge carries 5-21% risk of underlying cancer 3
Common Pitfalls to Avoid
- Do not confuse physiologic nipple discharge with pathologic discharge - blocked ducts in lactation may cause milk expression, which is normal; pathologic discharge is spontaneous, unilateral, from a single duct, and bloody or serous 3
- Do not delay evaluation of acquired nipple changes - new nipple inversion, unilateral discharge, or associated masses require immediate imaging to exclude malignancy 6
- Avoid premature surgical intervention - most blocked ducts in lactation resolve with conservative management or ultrasound therapy; surgery is reserved for chronic duct ectasia with severe symptoms or fistula formation 7, 8