Why lymphatic drainage and therapeutic breast massage don't help with breast inflammation

Massage can be a powerfully healing form of bodywork

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 looked after 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.

There is no reliable evidence to support the use of lymphatic drainage and therapeutic breast massage when you have breast inflammation

The breastfeeding support professionals who recommend lymphatic drainage or therapeutic breast massage typically point to one particular 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 suckle from the breast. The results of the study can be explained by the baby's breastfeeding alone.

Light massage circling around the breast and bringing fingertips up towards the armpit may feel pleasant for some women, but doesn'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.

The physiology of lymphatic drainage

The lymphatic capillaries open up when there is raised pressure from inflammatory fluids in the breast stroma. Tiny filaments connect the cells which make up the walls of the lymphatic capillaries to the connective tissue of the breast stroma. Lymphatic vessel cells are naturally pulled apart when fluid pressures inside the breast stroma increase, and the connective tissue swells. Fluid then easily diffuses in between the wide-open junctions between the cells, into the lymphatic capillaries.

Once inside the lymphatic capillary, lymph moves towards the nodes because of

• The subtle, rhythmic contraction which is a natural part of the function of lymphatic vessel walls

• One way valves, which prevent the lymph flowing backwards towards the tissues from which it came

• Compressing, massage pressures of the surrounding muscles and tissues. In the case of the breast, this comes from the natural movement of the breast as a woman's pectoral muscles contract and relax throughout the day, and as her breast moves around in relation to gravity.

It doesn't make biological sense to imagine that we can push or nudge fluid from the breast tissue or stroma into the lymphatic capillaries by hand. Unfortunately, if we apply enough mechanical pressure to change pressure gradients inside the breast stroma, we'll also be compressing the milk ducts, kneading the milk backwards towards the alveoli, and making the breast inflammation worse.

If you have a generous breast that has become inflamed, very gentle movement of the breast with the palm of your own hands might help

However, a lady with a generous breast might find that moving her breast with her own palms, in a way that doesn't hurt, helps create pressure changes within her breast stroma.

Why lymphatic drainage can seem to help

If you experience relief from a massage therapist who is applying therapeutic massage of the breast during a bout of breast inflammation, it may be because the gentle stimulation results in let-downs, which are the most effective way to relieve breast inflammation - but milk let-downs most easily and cheaply achieved by offering your breast to your baby!

Other women 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 to a masseuse in this way.

There are other much more effective steps that you can take when you have a breast inflammation, which don't require you to pay someone else to do.

In summary, lymphatic drainage or therapeutic massage of the breast lacks an evidence-base, and lacks any science-based physiological explanation showing how it might work. 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).

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.