Why lymphatic drainage and therapeutic breast massage don't help with breast inflammation
Massage has been an important part of my own life and self-care for decades. I am grateful for the skill and sensitivity of the many massage therapists who've cared for me.
It can seem rather ungenerous, then, to be saying to you that there's no reason to think that lymphatic drainage or therapeutic massage of your lactating breast will help prevent or resolve breast inflammation, including mastitis and engorgement.
Lymphatic drainage or therapeutic massage of the breast lacks an evidence-base, and lacks any science-based physiological explanation showing how it might work. I am concerned that the international promotion of a treatment without an evidence-base or physiological explanation (as has occurred in the Academy of Breastfeeding Medicine's Clinical Protocol #36 on The Mastitis Spectrum) drives up cost for families, including the cost of time and travel, and distracts fom more mundane treatments which you can do yourself and which are likely to help. It also means that breastfeeding women in low and middle income counties are unable to access something that is being promoted in advanced economies as an important part of care for a common breastfeeding problem (even if that information is inaccurate).
The breastfeeding support professionals who recommend lymphatic drainage or therapeutic breast massage typically point to a study which claims to show benefits of therapeutic breast massage for breast inflammations. Unfortunately though, in this study the therapeutic breast massage treatment included bringing baby on to the breast. The results of the study can be explained by the baby's suckling alone.
Light massage circling around the breast and bringing fingertips up towards the armpit may feel pleasant for some women, but it won't increase fluid drainage from the breast or from the area that is inflamed. That's not how the lymphatic vasculature of the breast works, actually. We can't push or nudge fluid from the breast tissue or stroma into lymphatic capillaries using mechanical pressure. Or, if we were applying enough mechanical pressure to perhaps act on the tiny filaments which connect the cells of the walls of the lymphatic capillaries so that they pulled apart and opened up more (which happens in response to raised pressure in the breast stroma or tissue), we'd also be compressing milk ducts and potentially making the breast inflammation worse.
There are other women who find therapeutic massage of their lactating breasts overly intimate and intrusive, given the great sensitivity of our breasts. These women prefer not to give intimate power over to a masseuse in this way.
There are other much more effective steps that you can take when you have a breast inflammation, and which don't require you to pay someone else to do.
Selected references
Douglas PS. Re-thinking benign inflammation of the lactating breast: classification, prevention, and management. Women's Health. 2022;18:doi: 10.1177/17455057221091349.
Douglas PS. Does the Academy of Breastfeeding Medicine Clinical Protocol #36 'The Mastitis Spectrum' promote overtreatment and risk worsened outcomes for breastfeeding families? Commentary. International Breastfeeding Journal. 2023;18:Article no. 51 https://doi.org/10.1186/s13006-13023-00588-13008.
Douglas, PS. Author's response to Comment on: Rethinking lactation-related breast inflammation: classification, prevention and management (letter to editor). Women's Health. 2023;19:doi: 10.1177/17455057231166452
Witt AM, Bolman M, Kredit S, Vanic A. Therapeutic breast massage in lactation for the management of engorgement, plugged ducts, and mastitis. Journal of Human Lactation. 2016;32(1):123-131.