Combining Therapeutic Ultrasound and Breast Massage for Plugged Ducts: Three casereports

Plugged ducts are a common problem during lactation. They often occur when the breast is not emptied properly, or when there is local pressure on the breast. Plugged ducts usually occur three to four weeks postpartum. Symptoms include a sensitive lump with well-defined margins in the breast. There may be pain and tenderness in the affected area, although this is not necessarily accompanied by systemic symptoms such as high-grade fever. Milk flow can be blocked and sometimes a tiny white spot can be seen at the opening of the mammary duct on the nipple. Without treatment, plugged ducts can lead to galactocele, mastitis or breast abscess. Traditional management of plugged ducts includes more frequent feeding or expression of milk, alternating breastfeeding position, using breast compression during feeding, and applying local heat and massage to the affected region. If these methods fail, therapeutic ultrasound has been suggested as an alternative treatment. The therapeutic effects of ultrasound can be divided into thermal and non-thermal. The heating effects have been proven to be of value in pain relief for breast engorgement and plugged ducts. However, the clinical significance of non-thermal effects in treating plugged ducts remains undetermined.We describe our experience combining therapeutic ultrasound and breast massage in the treatment of three patients with plugged ducts. In the first and second patients, after treatment, there were improvements in pain and lump resolve. Therapeutic ultrasound can decrease local pain and tenderness, which makes the patients more comfortable and tolerant to breast massage. Milk output increased, and patients felt they could breastfeed more easily. The only observed side effect was cavitation. In the third patient, who had symptomatic plugged ducts for one month, there was no response to combined ultrasound and massage therapy. She was referred back to her obstetrician and received fine needle aspiration. According to our experience, utilizing ultrasound and breast massage can be an effective alternative treatment for acute plugged ducts. The therapeutic dosage and the role of non-thermal effects, however, need to be determined by further controlled clinical trials.