Patients and providers frequently turn to IBCLCs with questions and concerns about chest/breast and nipple pain, plugged ducts, mastitis, and engorgement. Whether it is a patient newly postpartum who is so engorged the baby cannot latch, one who is experiencing recurrent plugged ducts, or one who is exhausted having sought out treatment after treatment for chronic pain, we all could use more tools in our toolbox to support patients and help resolve their issues.
Katrina B. Mitchell, MD is a board-certified general surgeon, fellowship-trained breast surgical oncologist, and International Board Certified Lactation Consultant (IBCLC) whose practice includes the care and surgery of women with breast cancer and benign breast disease, and also treats complications of lactation. Her webinar for ILCA, “Physical Therapy Techniques in Lactation” draws on both her own intimate knowledge of breast anatomy and physiology as well as the knowledge of the skilled physical therapists she works with. Below, she shares insights and techniques that can help IBCLCs help their patients.
The breast is a dense and complex organ
Mitchell emphasizes that the lactating breast is “an extremely complex organ”: highly vascular, drained by a complex lymphatic network, and highly innervated. Multiple branches of the intracostal and supraclavical nerves are present throughout the breast, and many extend all the way from the border of the breast to the nipple/areolar complex. Mitchell explains that for this reason, “Any kind of deep breast pain is going to radiate to the nipple, and any kind of nipple pain is going to radiate back deeper in the breast.” Similarly, lymphatic congestion anywhere in the breast can contribute to and interact with breast pain, engorgement, plugged ducts, and mastitis. When patients experience breast congestion, it is important to have multiple techniques available to relieve the pressure and improve drainage.
Deep massage = tissue damage
When a patient has plugged or congested areas of the breast, many of us were taught at some point in our training that firm massage starting behind the plugged area and pushing towards the nipple would help “push” a plug out. “I tell patients – because I’m the person seeing the consequences of aggressive massage – basically, if you’re massaging this gland, it’s like massaging a thyroid gland or some other gland,” Mitchell explains. “It’s just going to traumatize it.” She emphasizes that milk ducts are tiny – attempting to force milk through is very unlikely to work, and can cause significant issues. Excessive massage for a plugged duct or mastitis can cause a “lactational phlegmon” in that part of the breast, a complex mass of tissue that can’t be drained and can be challenging to manage.
Physical therapy techniques can be very effective for pain relief and breast drainage
For alternatives to these potentially harmful methods, Mitchell encourages more awareness of physical therapy techniques for management. She explains that breast surgeons generally work closely with physical therapists who are trained in lymphatic drainage and treating edema often associated with breast surgeries. She and the PTs she works with have found that many of the techniques can be very effective for treating issues with lactation as well. In particular, instead of deep massage, she encourages a lymphatic massage approach – with a light touch, “like petting a cat” – done with awareness of lymphatic drainage techniques of the breast. Understanding a few key techniques, and simple steps parents can be taught for self-care, can enable IBCLCs to put these principles into practice when caring for patients.
Want to learn more? In her webinar, “Physical Therapy Techniques in Lactation,” she shares photos of cases, high quality medical illustrations, and her understanding of the complex and fascinating anatomy of the breast. You will also learn the principles behind approaches like kinesiology taping, neural mobilization, and therapeutic ultrasound – techniques practiced primarily by physical therapists, but important for IBCLCs to understand for collaboration and referral.