Several months ago I posted about sore nipples, one of the most common complaints of breastfeeding mothers. Another relatively common complaint is breast pain. Breast pain can involve the entire breast or it can be localized to one area. The three primary causes of breast pain are engorgement, plugged ducts and mastitis.

Breast Engorgement

Engorgement refers to swelling of the breast tissue with milk. Engorgement occurring in the first one to four days postpartum usually coincides with your “milk coming in.” This type of engorgement affects both breasts and usually resolves spontaneously with minimal intervention. Application of cold compresses or ice packs, breast massage, hand expression of milk before and between feedings and use of Tylenol or Ibuprofen may provide relief. Engorgement can also happen if a feeding is skipped or your baby does not completely empty the breast. The best way to relieve this type of engorgement is to empty the breast using hand expression, pumping or nursing.

Plugged Ducts

When the pain is localized and corresponds with a lump or hardened area of the breast, a plugged duct is the most likely culprit. A plugged duct happens when a milk duct is not completely emptied. Plugged ducts usually resolve within 24-48 hours. Massaging the breast while nursing and applying warm compresses can help resolve plugged ducts more quickly. It may also help to position your baby with her chin pointing toward the plugged duct. If the plugged duct persists longer than 48 hours, ultrasound therapy may be used. This is usually done at a physical therapist’s office. Making sure the baby is positioned correctly with a good latch and wearing a well-fitting bra can help prevent plugged ducts.


When breast pain is localized and accompanied by redness or red streaks on the skin, mastitis is usually suspected. Mastitis can be accompanied by a fever and flu-like symptoms, but this is not always the case. Mastitis can often be managed conservatively for the first 24 hours without antibiotics. Conservative management involves frequent emptying of the breast, lots of rest, good hydration and nutrition and application of warm compresses. If symptoms worsen over 24 hours or have not improved after 24 hours, antibiotics are usually recommended. It is very important to remember that neither mastitis nor antibiotic use is a reason to stop nursing. A baby will not get sick nursing from an infected breast. In fact, breast milk has antibodies that help strengthen the baby’s immune system and protect him from infections.

If a nursing mom has breast pain or a painful breast lump that does not resolve or shrink within 1-2 weeks, she needs to be evaluated.

If you’re struggling with breastfeeding, contact your office – we want to help you be successful.