Hi Kathy,
I had a similar case and will offer this advise.  My mother complained of
recurring plug ducts which would be in either breast and in different
locations.  She tended to get them when she had gone back to work and was
pumping.  She was very aggressive with treatment because of fear of mastitis.
 When I saw her I found that the lumps she felt were not plug ducts but a
cluster of lumps outside of the milk glands.  She had an ultrasound and they
were found to be calcified tissue.  She has been followed with them and they
have resolved.
What I observed with this mother and my theory; when she found a lump she
increased pumping, nursing, heat and massage.  I believe she did this too
aggressively and her breast responding by edema to the area and actually
exacerbating the situation.  I do believe that some women are just more prone
to plug ducts and mastitis than others even when they do everything right.
Mother nature may not have laid down the perfect path for the alveoli and
there may well be some kinks and turns that do not always allow for an easy
flow.
After her ultrasound I had her cut back on her aggressive treatment and the
problem seem to have abated.  I also taught her how to identify the feel of
plug ducts and other kind of lumps in her breast.
Good luck with your client.
Ann Perry RN, IBCLC
Boston, MA

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