The Journal › Breast & Lactation Health
The Bosom Ritual™ Protocol: Your Evidence-Based Guide to Lymphatic Breast Massage for Mastitis, Engorgement & Blocked Ducts
Author: Erin Deger, Founder — Mammae
Contributor: Sophie Dulac, Lymphatic Practitioner
Published: October 2023
Updated: April 2025
If you are a breastfeeding mother navigating the pain of mastitis, engorgement, or a stubborn blocked duct, you are not alone, and you deserve care that is both gentle and grounded in evidence.
The Mammae Bosom Ritual™ Protocol is a practitioner-developed, step-by-step sequence of Manual Lymphatic Drainage (MLD) massage techniques, designed to support breast health, encourage healthy milk flow, and provide meaningful first-line relief from common breast inflammatory conditions.
Developed in close collaboration with Lymphatic Practitioner Sophie Dulac, and informed by the Academy of Breastfeeding Medicine (ABM) Clinical Protocol #36: The Mastitis Spectrum, Revised 2022, this protocol weaves together the wisdom of traditional therapeutic touch with modern, peer-reviewed clinical evidence.
In This Guide
- The Science: Lymphatic System & Breast Health
- Understanding the ABM Mastitis Spectrum 2022
- Who Can Benefit?
- Preparing for Your Ritual
- Step-by-Step Massage Sequence
- The Bosom Ritual™ Elixir
- What to Avoid
- When to Seek Medical Advice
- Frequently Asked Questions
- References & Further Reading
The Science: Your Lymphatic System & Breast Health
The lymphatic system is a critical — and often overlooked — component of breast health. It runs parallel to the circulatory system and performs three essential functions within the breast:
- Removing excess interstitial fluid that accumulates between cells during inflammation
- Transporting immune cells to sites of inflammation or infection
- Supporting the ecological balance of the breast milk microbiome
When the lymphatic system becomes congested — as it can during periods of hyperlactation, engorgement, or acute inflammation — fluid accumulates in the breast tissue, producing the hallmark pain, swelling, and heat associated with mastitis and related conditions.
Gentle Manual Lymphatic Drainage works with the body's natural physiology to encourage this fluid to move — reducing oedema and creating the conditions for the inflammatory process to resolve.
Key Principle: The breast is a glandular and lymphatic organ — not a muscle. It responds to gentle, feather-light stimulation, not to pressure, force, or vibration. This understanding is the foundation of the Bosom Ritual™ Protocol.
Understanding the ABM Mastitis Spectrum, Revised 2022
In 2022, the Academy of Breastfeeding Medicine (ABM) released a landmark revision of their clinical guidance: Clinical Protocol #36: The Mastitis Spectrum. This protocol replaced previous Protocols #4 and #20, and has meaningfully changed how evidence-based clinicians approach mastitis care worldwide.
Key clinical shifts from the 2022 guidance:
- Mastitis is a spectrum. Conditions exist on a continuum — from inflammatory mastitis through to bacterial mastitis, phlegmon, galactocele, and abscess.
- Reducing inflammation is the priority. Conservative, anti-inflammatory measures — including cold therapy and MLD — are recommended as first-line approaches before antibiotic prescription in many presentations.
- Aggressive massage is contraindicated. The ABM explicitly notes that aggressive breast massage and vigorous pumping can cause tissue trauma and may progress inflammatory mastitis to phlegmon or abscess.
- Milk microbiome health matters. Mammary dysbiosis — disruption of the breast milk microbiome — is now recognised as a contributing factor in recurrent mastitis.
- Prolonged heat is not recommended during acute inflammation. Despite longstanding advice, current evidence indicates heat can increase blood flow and worsen inflammation during acute episodes. Cold therapy is now preferred.
Clinical Reference: Mitchell KB, et al. (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, 17(5), 360–376.
PubMed PMID: 35576513 | DOI: 10.1089/bfm.2022.29207.kbm
Who Can Benefit From the Bosom Ritual™ Protocol?
This protocol is designed for a wide range of breastfeeding and postpartum experiences. You may benefit from regular practice if you are:
- A breastfeeding or expressing mother at any stage of your lactation journey
- Experiencing early signs of breast engorgement
- Navigating a developing blocked duct or milk bleb
- Supporting recovery from inflammatory mastitis, alongside healthcare provider guidance
- Seeking a proactive daily ritual to support long-term breast health and lymphatic function
- Wanting to incorporate a gentle self-breast examination practice into your daily life
- Pregnant and preparing breast tissue in the lead-up to lactation
Important: If you have been diagnosed with bacterial mastitis, an abscess, or any condition requiring medical treatment, use this protocol in conjunction with — not as a replacement for — care from your GP, IBCLC, midwife, or healthcare provider.
Preparing for Your Lymphatic Breast Massage Ritual
Lymphatic breast massage is intentionally gentle, distinct from other massage techniques in both pressure and purpose. The lymphatic system sits just beneath the skin's surface, and responds to feather-light stimulation, not deep massage or force.
- Feather-Light Touch: Begin with a touch so light it gently sweeps the surface of the skin.
- Flat, Open Hands: Use your whole hand rather than fingertips alone.
- Slow & Rhythmic Movements: Keep movements slow, steady, and methodical.
- Body Feedback: If you experience pain, sharp tenderness, or any discomfort, reduce your pressure.
- Consistency Over Intensity: Regular, gentle sessions are more effective than infrequent, forceful ones.
Recommended Frequency: For general breast wellness: once daily, 30 minutes. During active engorgement, blocked duct, or inflammatory mastitis: 2–3 sessions daily of 10 minutes each.
The Bosom Ritual™ Protocol Step-by-Step Lymphatic Breast Massage Sequence
This sequence has been developed by Lymphatic Practitioner Sophie Dulac in collaboration with the Mammae practitioner team. All steps should be performed with feather-light pressure.
Initiate the Ritual
Ground your senses before beginning. If you have the Ode Form Botanical Mist, gently swirl to activate the herbal infusion, then mist a generous veil around your body and space. Focus on your intention, and take three slow, diaphragmatic breaths.
1. Elixir Application
Warm a generous amount of the Bosom Ritual™ Elixir between your palms. Apply with gentle, sweeping motions to prime and nourish the breast tissue.
2. Lymph Node Activation — Axillary
The axillary nodes (armpit) are the primary drainage destination for breast lymph fluid.
- Raise the left arm; using your right hand, cup the axilla (armpit)
- Apply gentle, rhythmic pumping motions with the whole hand — 10 to 30 repetitions
- Reposition fingertips inside the armpit, cradling the lower breast; continue pumping
- Ground the heel of the hand on the sternum, direct fingertips outward toward the shoulder; continue the motion
3. Clear the Lymph Nodes — Rainbow & Horseshoe Strokes
- Rainbow stroke: Beginning at the centre of the sternum, sweep gently outward and upward toward the axillary nodes
- Horseshoe stroke: From the sternum's centre, sweep below the breast and upward toward the axillary nodes
4. Side Body Sweep
Begin at the lower rib cage or mid-waist. Using the whole hand, apply long, upward strokes toward the axillary nodes along the side of the body.
5. Supraclavicular Lymph Node Pumping
The supraclavicular nodes near the collarbone are a secondary drainage destination for breast lymph fluid.
- Position a flat hand just below the collarbone; apply gentle rhythmic pumping
- Lower the arm; position fingertips inside the armpit, cradling the lower breast; continue pumping
- Raise the arm again; using the whole hand, pump the axillary nodes to complete the circuit
6. Address a Blocked Duct — For Nursing Mothers
- Apply gentle circular motions around the perimeter of the blocked area — not directly over it
- Use a subtle, jiggling motion to mobilise the surrounding tissue
- Keep pressure feather-light; if pain increases, reduce pressure further
Critical: Proceed immediately to Step 7 after this step. Drainage strokes must follow activation to ensure fluid moves toward the lymph nodes rather than stagnating in the tissue.
7. Clear Lymph Nodes — Mandatory Following Step 6
Return to the Rainbow and Horseshoe strokes from Step 3.
8. Nipple Care — Bosom Ritual™ Balm
Specific to nursing mothers: sparingly apply the Bosom Ritual™ Balm to the nipple and areola for healing and protection between feeds.
Important: Always wipe off all residual balm thoroughly before breastfeeding to ensure an optimal latch and prevent your baby's mouth from slipping.
Close the Ritual
As you opened, close with the Ode Form Botanical Mist if available. Place both hands gently over your heart or breast, and take three slow exhales.
Direction of Massage — Always Remember: Every stroke moves away from the nipple, toward the armpit or collarbone. Never massage toward the nipple.
The Bosom Ritual™ Elixir: Your Therapeutic Partner
The Bosom Ritual™ Elixir is a multi award-winning, herbal-infused breast massage oil formulated specifically to support the lymphatic breast massage ritual.
- Provide ideal skin glide for feather-light MLD strokes without friction
- Support localised comfort through the gentle warmth generated when worked between the palms
- Offer complementary botanical anti-inflammatory and lactogenic support
- Encourage a meaningful daily ritual of self-care and intentional connection
Bosom Ritual™ Elixir — Lactation & Mastitis Care Lymphatic Breast Massage Oil
What to Avoid: Common Mistakes That Can Worsen Mastitis
Aggressive Massage or Attempting to “Break Up” a Clog
Forceful massage, deep kneading, epsom salt soaks and vibrating devices are not supported by current clinical evidence.
Prolonged Heat Application
Current evidence does not support prolonged heat during acute inflammation. Cold therapy is now clinically preferred.
Over-Pumping or Excessive Feeding on the Affected Side
Continue breastfeeding or expressing at your baby's normal pace — but do not increase frequency or volume with the aim of clearing a blockage. Read our full guide to safely managing a blocked duct
Delaying Medical Assessment When Symptoms Escalate
If symptoms worsen, persist, or are accompanied by fever or spreading redness, prompt medical assessment is essential.
When to Seek Medical Advice
Please contact your GP, IBCLC, Registered Midwife, or Maternal & Child Health Nurse without delay if you experience any of the following:
- Fever above 38.5°C
- Flu-like symptoms: chills, body aches, fatigue
- Redness that is spreading rapidly or streaking across the breast
- A hard, localised lump that does not improve within 12–24 hours of conservative care
- Pus or blood in your breast milk
- Symptoms that recur repeatedly despite conservative management
- Any concern that an abscess may be developing
Antibiotics for Mastitis? What Every Mother Needs to Know
Frequently Asked Questions
Is lymphatic breast massage safe during breastfeeding?
Yes. Gentle Manual Lymphatic Drainage (MLD), performed with feather-light strokes directed away from the nipple toward the axillary lymph nodes, is considered safe during breastfeeding.
How often should I practise the Bosom Ritual™ Protocol?
For general breast wellness, once daily for 30 minutes is recommended. During an active episode of engorgement, blocked duct, or inflammatory mastitis, you may practise two to three times daily in shorter 10-minute sessions.
Can I use the protocol if I currently have mastitis?
Gentle MLD is a recommended conservative first-line measure for inflammatory mastitis presentations, in line with ABM Protocol #36 (2022).
What is the difference between MLD and regular breast massage?
Manual Lymphatic Drainage uses feather-light, rhythmic strokes on the skin's surface to stimulate superficial lymphatic vessels.
Can I perform the Bosom Ritual™ Protocol during pregnancy?
Many of the foundational techniques can be safely adapted for pregnancy to support breast tissue preparation and general lymphatic health.
When should I see a doctor about mastitis?
Seek medical advice promptly if you develop fever above 38.5°C, flu-like symptoms, rapidly spreading redness, a lump that does not respond within 12–24 hours, pus or blood in breast milk, or if you are concerned about an abscess.
Protocol Disclaimer
Important: The Mammae Bosom Ritual™ Protocol is intended as a general guide to support breast and lactation health. It does not constitute medical advice and is not a substitute for the individualised guidance of a qualified healthcare professional.
If you have a pre-existing medical condition, are on medications, are pregnant, or have been diagnosed with any breast condition, please consult your healthcare provider before beginning this or any new self-care practice.
MLD breast massage is an adjunctive care technique and should not replace professional medical advice or treatment.
© Mammae The Embodied Mother Pty Ltd 2022. All rights reserved.
About the Authors
Erin Deger
Founder — Mammae
Erin Deger is the founder of Mammae, an award-winning Australian maternal wellness brand dedicated to redefining the standard of holistic breast and lactation care.
Sophie Dulac
Lymphatic Practitioner — Forme by Sophie Dulac
Sophie Dulac is a qualified Lymphatic Practitioner and the co-creator of the manual lymphatic drainage sequence at the heart of the Bosom Ritual™ Protocol.
formebysophiedulac.com
@form_bysophiedulac
References & Further Reading
The following peer-reviewed and clinical sources informed this protocol.
- Mitchell KB, et al. (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, 17(5), 360–376. doi.org/10.1089/bfm.2022.29207.kbm
- Academy of Breastfeeding Medicine — bfmed.org
- Australian Breastfeeding Association — breastfeeding.asn.au
- Lactation Consultants of Australia and New Zealand — lcanz.org
- Royal Australian College of General Practitioners — racgp.org.au
- Douglas P. (2023). Does ABM Clinical Protocol #36 “The Mastitis Spectrum” promote overtreatment? International Breastfeeding Journal, 18(1), 51. doi.org/10.1186/s13006-023-00588-8