A lovely client presented to clinic 7 weeks post vaginal delivery with a sore, hard left breast. This is her second child.

Presenting Concerns:

She has found that her baby has been becoming increasingly fussy at the breast over the last two days and her breast is now hard, red and sore. She does not have systemic fevers or chills so is confident that she does not have mastitis (which she knows the feeling of as she had mastitis multiple times while breastfeeding her first child). She is concerned about this breast as it is becoming increasingly sore and hard and her baby does not appear to be settling and content at the breast. She is needing to feed more off her right breast as a result which is starting to become uncomfortable also. When asked about recent changes to breastfeeding or sleep patterns she explained that three nights ago her baby had a long stretch of sleep throughout the night and she woke up very engorged and full. She pumped her right breast but was so tired that she just went back to sleep without pumping her left breast. When her baby woke up soon after she went back to bed, she then fed off her left breast and later that day the symptoms started in the left breast.


Upon observation, there is a reddened area of the left breast of around 5cm in diameter. Upon palpation, the affected area is warm to touch, hard and tender. The nipple is round with no apparent blistering or trauma. Her baby was asleep at the time of assessment so we did not carry out a feeding assessment as I wanted to carry out hands on treatment then get her to feed baby after to try to empty the breast effectively. Her bra is quite tight and is leaving marks and indentations across her breasts, back and shoulders.


My thoughts of diagnosis are landing on blocked milk ducts as opposed to mastitis as there are no systemic fevers yet. My differential diagnosis would be mastitis if hands on treatment doesn’t immediately bring relief.


I implemented a range of techniques aimed at emptying the breast:

  • Lymphatic drainage of the left neck, axilla and anterior chest wall
  • Breast massage
    • Gentle and pain free torsion massage
    • Gentle and pain free lift and stretch massage
  • Therapeutic Ultrasound to the affected area
  • Breast massage
    • Gentle and pain free torsion massage // At this point in time the breast started to have a let down which was lovely to see! When this happens we know that the blockage is starting to release
  • Breastfeed // I assessed at this point in time how baby was attaching and everything looked perfect. It was lovely to see the clients face as her baby established feeding on her left side – a look of relief and joy spread across her face and she beamed back at me saying that she felt the breast and lump was emptying! Her baby was not at all fussy and stayed happily at the breast.

Home Programme:

I suggested that the client continue the following at home:

  • Hot shower – use the jet on the shower head towards the area where the lump was forming. Alternatively, I suggested that she used her electric toothbrush head and gently massaged the affected area while in the shower.
  • Self massage – I gave specific instruction to carry out the gentle pain free torsion massage
  • After her baby finishes a feed ensure that that breast is as empty as possible. If she needs to pump after the feed has finished to empty especially that side – do it!
  • I gave her a compression singlet to wear and recommended that she gets out of her bra as much as possible
  • I recommended that she beg, buy or borrow sleep where possible
  • I also suggested that she ensure that she is drinking enough water and start taking lecithin
  • I suggested that if her baby ever has a long sleep again for her to get up and pump off BOTH breasts as she would usually be feeding to ensure that her breasts aren’t becoming engorged and sore.


I spoke to the client the following day, the lump was still there however it was much smaller. There was no reddening and absolutely no pain whatsoever. The baby was a lot more settled at the breast and appeared to be content after feeding off the left side. Within a week, there was no lump at all, no pain and baby was feeding beautifully off both sides.

This case was lovely as she responded beautifully to treatment. She had straightforward blocked milk ducts and did not have mastitis. She has had a wonderful breastfeeding experience since then.