I have been seeing really good results using ice/ cold packs on a plugged breast and vibration like from a small hand- held massager or electric toothbrush instead of warmth and massage. Sometimes massage seems to make it worse especially hard, deep muscle massage, but the vibration seems to break things up in there and the cold reduces generalized inflammation that the body does in response to the plug, enabling the milk to flow better again. We wouldn't put heat on a swollen ankle. Donna Geddes spoke of ultrasounds done on breasts with plugged duct and how much edema built up throughout the breast. Moms ave reported back that this cleared things quickly and there is no fever, why do antibiotics unless things get worse. The other old method we used to do way back  especially when the problem seemed close to the nipple, was to have mom bend over so her breast hung into a bowl of comfortably warm water and hand express sing gravity to help, express and roll the nipple, gently pulling and squeezing, gently, comfortably to get some change, movement in the breast.
Janet Dombro, Ibclc 


On Jan 29, 2013, at 9:51 AM, Laura Spitzfaden <[log in to unmask]> wrote:

> PTP
> 
> Mom is 20 days postpartum and began having painful engorgement of rt breast on day 14.  Two days later she had symptoms of mastitis--hard area on lower outer quadrant of right breast, redness, fever and flu-like symptoms.  She also developed many lumps just behind the nipple.  She used castor oil compresses, rest and frequent feeding and fever was gone within 24 hours.  Swelling is down somewhat but redness and plugs are still present 4 days after initial fever.   Milk is flowing a little better but plugs are not releasing.  She continues with compresses, positional changes and some pumping which is not very productive.
> 
> Part of the problem may be that baby has some signs of PTT and consistently leaves mom's nipples pinched.  Revision is being considered but will not happen in the next week at least.  At what point should she consider antibiotics?  She is very concerned about abscess but prefers to not take antibiotics.  She has nipple cracks but no pus or significant redness of her nipples.  She has no red streaks on her breast and no fever.
> 
> Most cases of plugged ducts/mastitis I have worked with have responded within 3 days to rest, frequent milk removal, massage and warm compresses.  What is the risk of continuing without antibiotics in absence of fever?
> 
> Laura Spitzfaden, LLLL, IBCLC
> 
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