For plugged ducts I routinely recommend cold packs between feedings, vibration rather than massage (think about breaking up plug rather than moving it), and a type of NSAID  like ibuprofen IF her doctor has okayed her taking Ibu. I had serious doubts about the heat and massage, felt like we were encouraging moms to distort the milk ducts leading to repeat plugs. Milk ducts aren’t straight lines after all.
Than I heard Donna Ramsey/ Geddes speak about ultrasounding the plugged breast and seeing inflammation as the root of the problem. She has been using the protocols above, and I have been sharing them with moms ever since. Moms routinely tell me what a huge difference it has made. 
I only recommend heat for nipple blebs and if she really wants to apply some RIGHT BEFORE the feeding only.
The few moms this doesn’t work for I do refer to ultrasound for therapeutic ultrasound that ideally breaks up the plug. The best would be visual ultrasound for location of plug, then therapeutic ultrasound to do the job, but nobody here does that-yet.
Janet Dombro, IBCLC 

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