What is the silent treatment good for?

Milk congestion

Milk congestion manifests itself with pain and hard lumps in the breast (© Jacek Chabraszewski)

Milk congestion is a very painful, hard spot in the chest. The hard spot can be small or cover a larger area and will not soften again through breastfeeding. As the milk congestion progresses, hard nodules, glandular tissue overflowing with milk, can be felt. The skin may be reddened over the affected area. Obstructive milk congestion can lead to bacterial infections (see breast inflammation).

Causes and Risk Factors

If the milk becomes blocked, the flow of milk is mechanically impeded:

  1. through a Cuticle at the opening of a milk ductas described under: white blisters on the nipple
  2. through a Fat plug. Between two breastfeeding meals, fat is usually deposited in the form of small globules on the wall of the milk ducts until a milk ejection reflex washes the fat globules towards the exit (nipples). When these globules clump together, milk congestion occurs.
  3. White sand-like granules have been observed in the milk of some mothers. It is believed that Calcium Granules form in breast milk and clog the milk ducts.
  4. It is also believed that dead cell clumps clog the milk ducts.

Most likely the plugs consist of a mixture of milk fat, dead cells and other solid milk components. During breastfeeding, the material usually dissolves or is washed out over time. Sometimes such plugs can be found directly on the nipple. When removed, they look like thickened spaghetti paste, sometimes brown, yellow, or green in color. The material is harmless to the baby.

The following risk factors increase the likelihood of a milk congestion:

  1. insufficient or infrequent emptying of the breaste.g. if the child is removed from the breast prematurely before the breast has been thoroughly emptied, or if there is an unusually long break between breastfeeding meals. Suddenly the child can drink less or not at all, e.g. when distracted, on a trip, caring for others, the mother is working or on a breastfeeding strike.
  2. copious milk production. The likelihood of a milk congestion is greatest in the first few weeks and months, when milk is abundant, and lowest when an older baby or toddler is drinking little milk. If the mother produces more milk than her child drinks (see Too Much Milk), her risk of recurring milk congestion is increased.
  3. Impairment of the milk ejection reflex E.g. through stress (visit, travel, time pressure, etc.), exhaustion, smoking or alcohol consumption by the mother. If the mother's milk ejection reflex is impaired, more milk remains in the breast and the baby receives less (see also When the milk ejection reflex is blocked).
  4. The Constriction of the chest with baby slings, pump funnels or a restrictive bra, e.g. an awkwardly fitting underwire bra that constricts the breast tissue. Milk ducts can temporarily “stick” or locally collapse under the pressure, so that the milk cannot flow through, or it can flow through poorly.

In summary, a "Milk stasis”The development of milk congestion. If milk remains in the breast, it will be reabsorbed into the bloodstream over time. The milk can thicken a little and occasionally clump together. This blocks the drainage in a milk duct (milk congestion).

The baby's chin should point towards the congested area. If the blockage is in an upper segment of the breast, the baby can be placed over the shoulder while breastfeeding. If an inside of the chest is congested, the cradle position is suitable, for an outer segment the football position and for a lower segment breastfeeding lying down (drawing: bearsky23).


The most important measure for treating milk congestion is regular and thorough emptying of the breast. The situation often improves on its own if the baby continues to be breastfed frequently (e.g. every 1–3 hours). In addition, the milk can be obtained manually or with the help of a breast pump if the baby does not empty the breast sufficiently. It is also recommended start with the affected breast when breastfeedingto empty this breast particularly effectively. To further promote effective emptying, the baby should be positioned during breastfeeding in such a way that his chin points towards the affected area. This is where the pull is strongest.

In order to dissolve the clumping and promote the flow of milk, a few minutes before breastfeeding or breast emptying can be applied to the affected area warmth can be applied, e.g. with a warm compress (please not too hot to avoid scalding).

For pain relief, the nursing mother may Painkiller take with the active ingredient ibuprofen or paracetamol, while she can continue breastfeeding (ask your doctor, pharmacist, midwife or lactation advisor).

The three-finger technique is shown in the video by Maya Bolman - at 2:08 minutes.

In order to dissolve the blocked milk, the breast can be opened with the help of the Three-finger technique can be emptied manually according to Maya Bolmann. Here, as always, the breast is emptied manually with the help of two fingers of one hand. A third finger on the second hand supports the emptying at the point where the milk obstruction is. Here the finger is first positioned near the nipple and works its way up towards the congestion.

When breastfeeding in Quadruped gravity supports the flow of milk.

After breastfeeding or emptying the breast Refrigeration applications Recommended: Quark wraps or cold compresses. The cold application should last about 20-30 minutes. The nipple should always be left out of a curd wrap, especially if the nipple is sore! Quark attacks the sensitive skin of the nipples, and the baby should not eat curd.

White cabbage leaves (rolled out with a rolling pin before use) can be placed in the bra between breastfeeding meals. White cabbage leaves have anti-inflammatory and cooling effects.

If you try to force the milk congestion out, the risk of a breast abscess increases. A breast massage should therefore only be carried out very carefully and gently and should not hurt! It can be a very gentle massage in front the milk congestion, i.e. between the nipple and the milk congestion (and not Behind or at the Milk congestion). If a plug obstructs the flow of milk, it is lying in front the milk congestion. You can start the gentle massage near the nipple and then slowly work your way towards the jam. The tissue is gently moved to loosen it and then brushed towards the nipple. The massage can be carried out under warm water, e.g. in the shower.

If the outlet of a milk duct on the nipple is blocked by an overgrown skin vesicle or a fat plug, the milk duct can pass through, for example, under a warm shower Rubbing or careful manual removal are reopened (do not squeeze!) (see white bubbles on the nipple).


In some women, milk congestion (temporarily) occurs again and again. To prevent further milk congestion, you can use your breast once a day Massage in the warm shower and several times a day before breastfeedingto loosen any clumps and adhesions. The Plata-Rueda massage can be performed within a few seconds so that the baby does not have to wait.

Affected women should make sure that their Breast is emptied regularly and thoroughly and there is no milk stasis. If your chest is tight, you can wake your baby to drink. If you are separated from your baby, you can empty your breast manually or with a pump during this time. If you introduce complementary foods, you should not skip breastfeeding, but rather continue breastfeeding frequently and distribute the complementary food in several small portions throughout the day (as recommended by the WHO). In this way, complementary foods can be introduced in a way that is gentle on the breast.

To ensure that all segments of the breast are properly emptied, the Alternated breastfeeding position become.

If the milk jams occur due to a temporary excess milk, the milk production can be reduced by cooling after breastfeeding. Cooling causes the blood vessels to contract and slow down all metabolic processes. In the first time after the birth it can take a few weeks for the milk production to adjust to the needs of the baby.

Women who have a tendency towards milk fat clumping can watch out for their intake of polyunsaturated fatty acids through their diet Lecithin Take (lecithin) in addition (e.g. 1 to 4 tablespoons of granules or 1–2 gastro-resistant capsules with 1200 mg each). Lecithin is an emulsifier and dissolves fat so that fat lumps are avoided. In the natural diet, lecithin occurs in vegetable seeds and egg yolks. In industry, lecithin is mostly obtained from soy.

If the milk congestion recurs, you can also Probiotics can be taken prophylactically for the lactating breast (more on this in the section on dysbiosis).

If milk congestion occurs in the same place over and over again, a fibrocystic mastopathy (nodular proliferation of the breast connective tissue) or a tumor may be considered. In such cases, it is advisable to be examined by a gynecologist. Usually these are benign changes in the breast.


  • Bolman M: The art of therapeutic breast massage in supporting breastfeeding. Lecture at the ELACTA Congress May-July 2020.
  • Lawers J, Swisher A: Conseling the Nursing Mother. A Lactation Consultant's Guide. 6. On. 2016. pp. 393-394.
  • Walker M: Breastfeeding Management for the Clinician. Using the Evidence. 4th ed. 2016. pp. 605-606.
  • Berens P, Eglash A, Malloy M, Steube A, Academy of Breastfeedinf Medicine: ABM Clinical Protocol # 26: Persistent Pain with Breastfeeding. Breastfeeding Medicine 2016; 11 (2).
  • Monastery I: breastfeeding management in various breastfeeding situations. Seminar of the Lactation & Breastfeeding Training Center, August 2019.
  • S3 guideline for the treatment of inflammatory breast diseases during breastfeeding 2013.
  • Lawrence RA and Lawrence RM: Breastfeeding. A guide for the medical profession. 5th edition, 1999, Mosby and 6th edition, 2005, Elsevier Mosby
  • Riordan J and Auerbach KG: Breastfeeding and Human Lactation, 2nd edition, 1999; Jones and Bartlett Publishers


Further online publications on the topic:

© Dr. Z. Bauer - Publications in Breastfeeding Promotion. 2003-2020. Last revision: June 2020.