Milk Stasis

Milk stasis is retention of milk in part or all of the breast because milk is not removed effectively, causing a firm tender area without infection. It results from missed or short feeds, poor latch, tight clothing or bras, sudden weaning, oversupply and nipple pain that limits feeding. It matters because untreated stasis progresses to a blocked duct and mastitis, and it is easily corrected by milk removal.

• Risk factors: infrequent or skipped feeds, pressure on the breast from a bra or strap, oversupply, infant with weak suck, sleeping through feeds, return to work, nipple pain, previous mastitis.
• Usually involves one breast.
• Settles within 24 to 48 hours with frequent milk removal.

Women have a localised area of fullness, firmness or tenderness in one breast, with warmth and sometimes mild redness, but no systemic illness. The area softens after feeds.

• Tender firm area without a sharp border.
• Temperature below 38 degrees Celsius.
• Differential diagnosis: blocked milk duct, mastitis, engorgement, galactocele, breast abscess, fibroadenoma, lactating adenoma, inflammatory breast cancer.
• Complications: blocked duct, mastitis, breast abscess, reduced milk supply, early weaning.

The diagnosis is clinical, with an assessment of feeding.

• Palpate the breast for a firm area, warmth and redness; check the axilla for tender nodes.
• Observe a feed for latch and positioning, and enquire about feeding frequency and bra pressure.
• Temperature and pulse.
• Breast ultrasound if a lump persists more than 2 weeks or if it is hard and fixed.

The principle is frequent, effective milk removal and gentle care of the breast.

• Supportive: feed on demand at least every 2 to 3 hours, starting on the affected side with the baby's chin pointing to the firm area; gentle lymphatic massage toward the armpit before and during feeds (light pressure only); warm compress for 3 to 5 minutes before feeds; cold compress for 15 minutes after feeds; remove tight bras and straps; rest and fluids; hand express or pump to comfort if the baby does not empty the breast.
• Pharmacological: paracetamol 1 g oral 6-hourly (maximum 4 g in 24 hours); ibuprofen 400 mg oral 8-hourly with food for 3 to 5 days; sunflower lecithin 1200 mg oral 3 to 4 times daily for recurrent stasis.
• Procedures: none.
• Red flags: fever above 38.5 degrees Celsius, chills, red wedge-shaped area, hard lump persisting beyond 48 hours, nipple pus, severe pain, general illness.
• Follow-up: review in 48 hours by phone or visit; if fever or redness develops, mastitis is diagnosed and treated with flucloxacillin 500 mg oral 6-hourly for 10 days; review at 1 week; lactation support for recurrent stasis.