common lactation problems

Breastfeeding women with plugged milk ducts typically have breast pain and tenderness, palpable masses, and no signs of infection.  Poor feeding technique, a decrease in feeding, inadequate emptying, and stasis can lead to breast engorgement (ie, breast tissue distension) and subsequent blockage of milk ducts.  Treatment of plugged ducts includes optimizing feeding technique, continued breastfeeding, and symptomatic relief (eg, warm compresses, manual massage, nonsteroidal anti-inflammatory drugs).

A galactocele is a large, milk-retaining cyst due to a blocked milk duct.  Galactoceles are painless and typically resolve.  If the galactocele persists, ultrasound (with or without aspiration) may be used to differentiate it from malignancy.

During lactation, breast pain can occur due to engorgement of normal breast tissue; however, there are no associated lumps.  Lactational mastitis is a complication of engorgement and plugged milk ducts.  Patients typically have fever, localized breast pain, and erythema, not a mass.  Lactational mastitis requires no imaging.  Treatment is symptomatic (eg, nonsteroidal anti-inflammatory drugs, continued breastfeeding) and a course of antibiotics (eg, dicloxacillin, cephalexin) that provides coverage against Staphylococcus aureus.  Untreated lactational mastitis can progress to abscess.

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