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Randomized Controlled Trial
. 2022 Jun 2;17(1):43.
doi: 10.1186/s13006-022-00485-6.

Integrated breast massage versus traditional breast massage for treatment of plugged milk duct in lactating women: a randomized controlled trial

Nutchanat Munsittikul  1 , Supannee Tantaobharse  1 , Pitiporn Siripattanapipong  2 , Punnanee Wutthigate  2 , Sopapan Ngerncham  2 , Buranee Yangthara  3
Affiliations
Randomized Controlled Trial

Integrated breast massage versus traditional breast massage for treatment of plugged milk duct in lactating women: a randomized controlled trial

Nutchanat Munsittikul et al. Int Breastfeed J. .

Abstract

Background: Plugged milk duct during lactation is a common problem in breastfeeding. Traditional breast massage (TBM) has been performed in Thailand with reasonable outcomes, but several follow-up sessions are often required. A new massage technique, the integrated breast massage (IBM), was subsequently developed. This study aimed to compare resolution time, reduction in mass size, and pain score after breast massage between the IBM and TBM techniques.

Methods: This randomized controlled trial was conducted at the Lactation Clinic of the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during February 2019-July 2020. Women presenting with acute plugged milk duct were enrolled and randomly allocated to the IBM or TBM/control groups. Mass size in square centimeters (cm2) was calculated by multiplying the perpendicular axes of the mass. Pain score was self-scored by participants using a numerical rating scale. Median time (95% confidence interval [CI]) to resolution of plugged milk duct was derived using Kaplan-Meier survival analysis. Intention-to-treat analysis was performed.

Results: Eighty-four women (42 per group) were included. All enrolled study participants completed the study and were included in the final analysis. Twenty-six (61.9%) and 25 (59.5%) participants from IBM and TBM, respectively, had mass diameter > 5 cm. The median (interquartile range [IQR]) mass size was 30 (20-48) and 20 (12-14) cm2 in IBM and TBM (p = 0.05), respectively. The median (95% CI) time to resolution of plugged duct was 0 (not available) and 1 (0.47-1.53) day in IBM and TBM, respectively (p < 0.01). After the first breast massage, the median (IQR) size of mass reduction was 30 (20-48) and 10 (10-26) cm2 in IBM and TBM, respectively (p = 0.01). The median (IQR) reduction in pain score was 8 (7-8) and 6 (4-7) in IBM and TBM, respectively (p = 0.01). No participants developed skin bruising or hematoma after breast massage.

Conclusions: The IBM technique resolved plugged milk duct significantly faster, with significantly less pain, and with significantly greater reduction in mass size after the first massage compared to TBM.

Trial registration: Retrospectively registered in the Thai Clinical Trials Registry on 25 September 2019 ( TCTR20190925001 ).

Keywords: Integrated breast massage; Lactating women; Plugged milk ducts; Traditional breast massage; Treatment.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Pictorial images of the integrated breast massage technique with the massage therapist standing behind the patient’s head. A Butterfly stroke: Apply continuous pressure to the affected breast while moving along the base of the breast from the medial side to the axillary area. Then repeat the same motion at the upper half of the breast. B Fingertip circle: With the fingers of one hand, lightly press and massage the breast in a circular motion while moving around the areola. C, D, E Diamond stroke. C: The breast is positioned between the fingers and thumbs of both hands (resembling a diamond shape), followed by both hands moving toward each other and toward the areola. D: Alternating between hands, press the breast with the palmar side of the 2nd to 5th fingers, and then release (resembling patting on the breast). E: With the tips of the 2nd to 5th fingers, press into the breast gently, then move both hands away from each other with an action that is similar to scratching. Repeat the same motions around the breast toward the axillary area. F Promotion of milk duct dilatation: Gently squeeze and roll the areolar area between the thumb and forefinger. G Augmentation of milk drainage from areas with plugged milk ducts: Gently fix and squeeze the breast mass with the non-dominant hand while the dominant hand manually expresses breast milk by gently compressing the areola and nipple between the thumb and index finger
Fig. 2
Fig. 2
Diagram demonstrating the flow of participants in this study. *Two cases in the traditional breast massage group received integrated breast massage on the second visit due to their experiencing a < 20% reduction in mass size after receiving traditional breast massage
Fig. 3
Fig. 3
Kaplan–Meier survival curve analysis comparing the duration of plugged milk duct treatment between integrated breast massage (IBM) and traditional breast massage (TBM)
Fig. 4
Fig. 4
Change in median mass size (box plot) and number of participants with remaining breast mass (line plot) at each follow-up visit. A TBM, traditional breast massage and B IBM, integrated breast massage
See this image and copyright information in PMC

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