Preventing milk pimples and plugged ducts

How can I prevent milk pimples and plugged ducts?

There is little research in the area but we have found that preventing milk pimples and plugged ducts requires regular and effective movement of milk out of the breast by breastfeeding. Expression is less effective at moving milk for some mothers. After breastfeeding, mothers should check their breasts for areas that haven’t emptied. Fuller areas should be massaged. If they don’t soften after several strokes, there may be a plugged duct that requires attention. Mothers can use gentle breast massage before and after breastfeeding to prevent milk stasis. Milk production should not be over-stimulated by expression and some mothers with an excessively large milk supply may need to decrease it. Some mothers find lecithin useful. It is a refined naturally occurring substance that may prevent breast milk fat from solidifying and causing milk pimples or plugging ducts.

A) Describing the prevention of milk pimples and plugged ducts

Milk pimples and plugged ducts are often present together and their prevention overlaps.

There is very little research on the prevention of milk pimples and plugged ducts. The following information is based on the experience of our clinic and on common approaches by other providers, and focuses on effective milk removal, avoiding milk over-production, and the use of lecithin to prevent the clotting of milk (Mitchell 2020).

B) Ensure regular and effective milk removal

Milk removal must be regular and effective. To do this, ensure the baby is breastfeeding effectively and: 

If the baby is being supplemented: 

In addition:

If your baby changes the feeding pattern and your breasts become very full, consider occasional expressing to comfort until the breasts adjust to the new pattern.

We have not found bras to be a frequent cause of plugged ducts. However, consider changing your bra if it cuts into an area of the breast that has become plugged.

C) Avoid an overstimulated milk supply

Some mothers keep their milk supply artificially high by expressing a lot in addition to breastfeeding. Consider slowly decreasing the amounts you pump as your fullness allows.

Mothers with a large milk supply are more likely to have milk pimples and plugged ducts. On rare occasions, mothers find that they need to reduce their milk supply.

D) Lecithin

1) What is lecithin?

Lecithins are a group of naturally occurring ingredients found in soybeans, sunflower seeds, canola, cottonseed, eggs, marine sources, and animal fat. They contain a mixture of molecules called glycerophospholipids as well as other fats. The exact makeup depends on the origin of the lecithin. Processing also affects the levels of lecithin components.

Commercial lecithin supplements have been generally made from soybeans and most soybeans are genetically modified (GMO). Recently, there has been an increase in the use of lecithin made from sunflower seeds because of concerns about soy allergy and the health and environmental effects of GMO crops. In addition, sunflower lecithin is generally extracted by cold-pressing (mechanical) whereas soy extraction often uses chemicals such as hexane and acetone.

Lecithin can be certified organic and: 

  • Made without GMOs.
  • Grown without synthetic fertilizers or pesticides.
  • Processed without chemicals.

There does not seem to be a significant difference in the main ingredients of soy or sunflower lecithin (Krüger 2015).

2) How does it work?

Lecithin acts as a soap (emulsifier), allowing water and oily substances to mix. It is added to many products, including medication, animal food, paint, and plastics. It is used in foods such as chocolate, bread, ice cream, and margarines.

Lecithin may act as in emulsifier in breast milk and prevent the fat from solidifying and causing milk pimples or plugging ducts.

Some mothers have found taking lecithin useful, but there are no studies to support this (McGuire 2015). 

If the cause of milk pimples is milk leaking between the layers of nipple skin, lecithin is unlikely to help prevent them.

3) Safety

Lecithin is considered a generally safe food additive and supplement. One study (Fisher 2010) showed that a lecithin supplement of 5,400 milligrams a day was safe for pregnant mothers, at least in the short term.

Lecithin may cause nausea and other gut symptoms.

Soy lecithin is highly processed and unlikely to contain significant amounts of protein. However, individuals who are allergic to soy may wish to use sunflower seeds lecithin.

There is some concern that the processing of lecithin by the gut releases a chemical that can contribute to heart disease (Russell 2013). Do not use lecithin over the long term and consider stopping every three to six months and only resuming it if needed.

Lecithin and other supplements are not as closely monitored for safety and effectiveness as is prescription medication. Supplements may contain unexpected ingredients or contaminants, vary from batch to batch, and be incorrectly labelled. Consider choosing a reliable manufacturer whose products are made in a country that has high standards.

4) Taking lecithin

Lecithin can be found in the health-food section of stores and is available as liquid, powder, granules, and in capsules. The capsules are easiest to swallow. Powder and granules need to be added to other foods or liquids.

For mothers who want to try lecithin, a typical dose is one 1,200 mg capsule at each meal and one at bedtime.

These doses can be doubled if mothers tolerate the original dose, and if they continue to get milk pimples or plugged ducts.

References

Krüger S, Bürmann L, Morlock GE. Comparison and characterization of soybean and sunflower lecithins used for chocolate production by high-performance thin-layer chromatography with fluorescence detection and electrospray mass spectrometry. J Agric Food Chem. 2015 Mar 25;63(11):2893-901
 
McGuire E. Case study: white spot and lecithin. Breastfeeding Review 2015; 23(1); 23-25

Mitchell KB, Johnson HM. Breast Pathology That Contributes to Dysfunction of Human Lactation: a Spotlight on Nipple Blebs. J Mammary Gland Biol Neoplasia. 2020 Jun;25(2):79-83 

Russell WR, Hoyles L, Flint HJ, et al. Colonic bacterial metabolites and human health. Curr Opin Microbiol. 2013 Jun;16(3):246-54