6 Tips to Avoid Engorged Breasts and Mastitis from Allyson Murphy, IBCLC

As any breastfeeding parent knows, feeding a baby with your body can be beautiful, but it's also not always a walk in the park. Aside from the aches or tingling of breastfeeding let down and the discomfort of cracked nipples, many also have to deal with breast engorgement, plugged breast ducts, and mastitis.

According to the Mayo Clinic, engorgement happens when milk is not fully removed from the breasts—for example, during breast weaning or if you produce more milk than your baby consumes. Breast engorgement can result in plugged milk ducts, which present as hard lumps or localized breast pain and breast swelling. Mastitis is inflammation (sometimes infection) of the breast tissue, often associated with clogged breast ducts, skin irritation, or cracked nipples—and yes, it's super painful too.

Thankfully, there's relief. We consulted with International Board Certified Lactation Consultant Allyson Murphy on her best advice for avoiding and treating breast engorgement and mastitis.

Engorgement, clogged milk ducts, and mastitis are major sources of stress during breastfeeding or chestfeeding. It’s normal to feel uncomfortably full when mature milk first comes in around days 3–5 of postpartum recovery. The chest may feel warm, very firm, and tender to the touch. This usually lasts about 24 hours.

Breast engorgement can recur as you’re weaning or if your baby doesn’t fully consume the milk you produce. This can result in plugged breast ducts—a blockage in the tunnel of the breast duct that prevents milk from clearing behind it, often presenting as a hard spot that doesn’t resolve after feeding or breast pumping.

Unresolved plugs can lead to mastitis, which causes inflammation and often infection. Mastitis symptoms may include fever, chills, body aches, soreness, and redness. Antibiotics may be needed to treat mastitis, and while frequent milk removal used to be the go-to, recommendations have since changed.

Allyson Murphy’s 6 Tips for Avoiding Breast Engorgement, Clogged Ducts, and Mastitis:

1. Feed on demand, not on a schedule

One of the best rules for nursing is to watch the baby, not the clock. Newborns often feed 12 or more times a day. Their bellies are small, and they need to eat often. Never limit feeding time or try to stretch time between feeds—doing so can disrupt the body’s communication with your baby’s needs, leading to engorgement.

2. Avoid underwire bras

Always choose nursing or pumping bras without underwires. Wires and tight-fitting bras can put pressure on the breast and chest and contribute to clogged ducts. We love Nyssa’s FourthWear Postpartum Recovery Bralette—soft, stretchy, and designed to hold ice or heat packs for relief during engorgement, weaning, or lactation suppression.

3. Use the correct flange size and pump settings

Proper flange fit helps with effective milk removal. The nipple should move easily in the tunnel without rubbing, but also not be so large that the areola gets pulled in.

Varying your pump's speed and cycle settings—alternating between stimulation and expression modes—can trigger multiple letdowns and improve output. A lactation consultant can help determine your correct flange size and pump settings.

4. Treat clogs as soon as they appear

If you feel a clog coming on, act quickly.

Here’s what Allyson recommends:

Ice the affected breast for 10–20 minutes before each nursing or pumping session to reduce inflammation. Try Nyssa's Breast & Chest Reusable Ice/Heat Packs.

Take ibuprofen as directed to help with inflammation and pain.
Use the techniques in this video. Lightly massage toward the armpit BEFORE nursing or pumping. Gently massage over the area DURING nursing/pumping. Follow AFTER with hand expression.
Take sunflower lecithin for stubborn clogs (see Kellymom for dosage)
Rest as much as possible

It’s Important To Note:
The protocol for mastitis changed in Spring 2022. Previously recommended treatments like heat and very frequent pumping are now discouraged during active mastitis, as they can increase inflammation and milk supply.

Learn more in this article from Motherlove: What to Know About the New Mastitis Protocols

5. Work with an IBCLC to check your latch

If clogs or engorgement keep coming back, get help from an International Board Certified Lactation Consultant (IBCLC). A shallow latch may lead to incomplete milk removal. An IBCLC can assess your baby’s latch and oral motor function and offer a care plan to improve nursing and avoid recurring plugs or mastitis.

6. When weaning, go slowly

When it’s time to stop nursing or pumping, wean gradually:

Drop one session every 3 to 5 days
Don’t rush—pump or feed fully during remaining sessions
If you’re uncomfortably full, express just enough to relieve pressure

Slow weaning gives your body time to adjust and reduces the risk of engorgement and plugged ducts.

If you have any signs of mastitis, especially fever, chills, redness, or flu-like symptoms, contact your OB, midwife, or lactation consultant immediately.

The Bottom Line: Caring for Your Body Is Caring For Your Baby

Caring for your body while feeding your baby is as important as caring for your baby. Breast engorgement, clogged ducts, and mastitis can be painful and overwhelming, but they’re also manageable and, in many cases, preventable with the right guidance and support. Whether you’re nursing, pumping, or weaning, these tips from Allyson Murphy, IBCLC, can help you stay ahead of discomfort and protect your breastfeeding journey. And remember: if something doesn’t feel right, don’t wait; reach out to a trusted healthcare provider.