Plugged Duct, Mastitis, or Abscess?
What do I have?
Marie Davis, RN, IBCLC


Plugged Duct


Breast tender in the area of the plug. 

Plug will feel like a small knot.

May appear as a small white bleb on the surface of the nipple.

The breast should not appear inflamed or reddened.

No Fever: no systemic symptoms


Red, inflamed area on breast or red streaks on breast. 

Fever. Chills. 

Body aches. 


Flu like symptoms: Diarrhea, nausea, vomiting. 

History of recent plugged duct.

History of recent inadequate breast emptying: Recently returned to work, baby begun sleeping through the night or sudden weaning.

Recent breast injury or sore nipples with breaks in the nipple or areolar tissue. 


History of  delayed [ > 24 hours from start of symptoms] or inadequate treatment of mastitis. 

Area may no longer be painful. 

Systemic symptoms may be absent. 

Area of the abscess may look discolored or bruised.

The abscessed area has risen to the surface of the breast tissue and is indurated (hard) in the center. 

Has a soft, mushy spot in the center right before rupture.

Apply Home Treatment (listed below) Call your doctor or Lactation Consultant for medication and treatment. You should be seen by your doctor as soon as possible: in less than 24 hours after the symptoms started. See your doctor now. 
This is considered a medical emergency.

Home Treatment:

Moist heat to affected breast.

Manual expression to assist in removing the plug.

Nurse or pump every two hours, beginning each feeding with the affected breast.

Alter position of infant at breast to assist in removing plug.The infant's chin should be near the area of the plug.


Remove any constrictive clothing and/or bra.

 Take oral temperature every four hours, report any fever over 101° F to medical provider.

Watch for aches and pains, flu like  symptoms.

Watch for increasing redness and pain.

SUGGESTED MEDICATION PROTOCOLS: Dicloxacillin 250 or 500 mg 
If allergic to Dicloxacillin, or Penicillin: 
Erythromycin 333 mg., 
Medication Schedule: 1 capsule, every 6 hours, for 10 to 14 days. 
If allergic to both Dicloxacillin, Penicillin or Erythromycin: can use Keflex 500 mg., 1 capsule, every 6 hours, for 10 days (Delayed response when the medication prescribed is Keflex has been observed in the lactation clinic)
Take the antibiotics on a regular schedule. If the bottle says take 4 times a day that doesn't mean before breakfast, lunch, dinner and at bedtime.
It means taking it every 6 hours around the clock (I tell moms to use a 6-12-6-12 schedule because it is easier to remember)

Home treatment: 

Strict bed rest until systemic symptoms (fever, headache, body aches) are absent, usually within 72 hours after starting antibiotics.
Strict bedrest means: you can feed the baby, shower once a day and get up and go to the bathroom as needed. The rest of the time you should be in bed.  It has been proven that fatigue leaves mom's body wide open for these infections because fatigue and stress decrease our body's immune response.

Nurse or pump the affected side every two hours.  Keep the breast as "empty" as possible. This serves two purposes. It brings the level of antibiotic up in the breast itself by increasing blood flow to the area and keeps the milk from stagnating which gives the offending bacteria a wonderful place to grow. If the bacteria grows unchecked the body will wall it off (which becomes an abscess). 

Moist heat to affected breast. 

Removal of bra and constrictive clothing. 

Increase fluid intake. 
Start taking several million units of live Acidophilus several times a day to prevent the GI problems which include gas, bloating and diarrhea. The Acidophilus will also help prevent thrush.

Report any increase of symptoms to the medical provider immediately. 

Return to the medical provider for further evaluation before refilling the prescription.

Most cases of mastitis are caused by simple skin staph. However, if mastitis recurs after one or two rounds of antibiotics, ask that the baby's nose and throat be cultured to make sure baby isn't a hidden strep carrier.

Medical treatment: 

Surgical incision and drainage.

Hospitalization for IV antibiotics as  needed. 

Continue to nurse the baby or pump on a regular schedule. 

Cover incision  with a clean dressing at  each feeding. 

Breastmilk is not harmful to the incision as the  macrophages in the milk will assist in the destruction of the offending bacteria and aid in the healing process. 

Copyright Marie Davis, RN, IBCLC 1999
revised: Saturday, September 11, 2010