What is breast engorgement?
Breast engorgement occurs when the breasts are overfilled with milk and swollen, causing them to feel firm, tender, and painful. This can occur 3 to 5 days after delivering a baby, due to the onset of copious milk production (called primary breast engorgement), or at any time during the postpartum period when milk supply exceeds milk removal (called secondary breast engorgement). Strategies to manage and prevent engorgement are important because this condition increases the risk for breastfeeding problems like mastitis, clogged ducts, latching difficulties, infant feeding refusal, and premature cessation of breastfeeding.[1]
What are the main signs and symptoms of breast engorgement?
When the breasts are engorged with milk and swollen, some common signs and symptoms appear in one or (more often) both breasts. The breasts can feel firm, tender, tight, painful, warm, and even lumpy. They will look larger, can be uneven or lopsided, and the skin covering them may appear shiny (due to being stretched) and have more visible veins. The swelling sometimes extends to the armpit or across the sternum and can also affect the nipples, making them firm and flat (or even inverted).[2] Systemically, a mildly elevated body temperature may be present.[3] These signs and symptoms can ebb and flow, remain constant, or progressively worsen with time.[4] It is considered normal to experience some degree of breast engorgement in the first week after giving birth.[5]
How is breast engorgement diagnosed?
Breast engorgement is a clinical diagnosis that is made based on the presenting signs and symptoms.[6] There is no test or imaging needed to make the diagnosis. If symptoms worsen or a fever develops, it is important to seek medical attention because breast engorgement can precede mastitis, clogged ducts, and other more serious conditions (like a breast abscess).[3]
What are some of the main medical treatments for breast engorgement?
Most of the treatments for breast engorgement can be done at home and are centered around effective removal of milk through frequent (but not excessive) breastfeeding or pumping with proper technique. Medical management usually isn’t required, especially for self-limiting cases of primary engorgement. Over-the-counter pain relievers, such as ibuprofen and acetaminophen, can be taken at the appropriate dose to reduce symptoms and improve comfort. These medications are safe to take while breastfeeding.[5] Antibiotics are not appropriate for breast engorgement, although they may be used to treat some cases of mastitis.
Have any supplements been studied for breast engorgement?
There is no evidence to support the use of oral supplements in the treatment of breast engorgement, but there are studies on the use of supplements to increase or decrease breast milk production, as found on the lactation page.
Sunflower lecithin is commonly used in the context of breast engorgement to prevent clogged milk ducts by making breast milk “less sticky”. However, there are no controlled trials to support this claim. Similarly, probiotics, specifically Lactobacillus salivarius and Lactobacillus fermentum, are sometimes used during breast engorgement to prevent mastitis, but high-quality evidence for this practice does not yet exist.[7][8]
How could diet affect breast engorgement?
Diet, including fluid intake, is unlikely to affect breast engorgement, and there are no studies linking diet to the presence or absence of breast engorgement. The volume of milk that a lactating parent produces is primarily driven by the amount of milk that is removed from the breasts,[9] not by the dietary choices of the parent.[10]
Are there any other treatments for breast engorgement?
Frequent (but not excessive) removal of breast milk is the primary treatment for breast engorgement, which means either the infant or a pump must effectively drain milk from the breasts. If breastfeeding, there are some simple techniques to help an infant achieve better feeds from an engorged breast and thus treat the condition. Manual expression of small amounts of milk prior to beginning a feed can soften the breast and help the infant latch onto the nipple more easily. Just remember to keep the amount of expressed milk small because overstimulation will worsen the problem. Reverse pressure softening, pressing into the chest wall with 2 fingers on each side of the nipple, can also help an infant latch on by pushing fluid away from the nipple. If the engorgement is causing a strong let down (ejection of milk), breastfeeding in a reclined position can slow the flow of milk and improve infant feeding.[5][3]
Comfort measures are another important aspect of treating breast engorgement. One of the most common methods of reducing pain from engorgement is the use of cold compresses for 15 to 20 minutes between feedings. The compress can be an ice pack, a bag of frozen vegetables, cabbage leaves, or an herbal compress.[1] Heat, applied via a warm shower or warm pack, is sometimes used to facilitate milk removal; however, heat should be limited to only a few minutes immediately prior to a feeding because heat increases blood flow and can worsen breast swelling. Breast massage, acupuncture, and ultrasound therapies have also been used to treat breast engorgement, but there is limited evidence on their efficacy. Of the three methods, gentle massage is the most promising for symptom relief.[5] Additionally, wearing a well-fitting bra that is supportive but not overly tight can reduce discomfort.
What causes breast engorgement?
Primary breast engorgement is caused by hormonal shifts that cue the production of copious amounts of milk, and these shifts are called lactogenesis II or the second stage of milk production. During this stage, there is a rapid drop in progesterone and a rise in prolactin, cortisol, and insulin, which stimulate breast milk to “come in” and replace colostrum (the “first milk”).[11] This sudden increase in milk production and interstitial fluid volume causes breast swelling and the signs and symptoms of engorgement. When no complications are present and feeding techniques are effective, it is a self-limiting condition that resolves within the first week postpartum as milk production regulates to match infant demand.[1]
Secondary breast engorgement occurs later in the postpartum period when there is a mismatch between milk production and milk removal.[3] There are a wide variety of reasons why this might happen, some related to the lactating parent, some to the infant, and some to both. Examples include a hormonal imbalance in the parent that increases milk production (like hyperthyroidism), pumping too frequently and stimulating excessive milk production, breastfeeding difficulties (like poor latch or positioning), and decreased infant feeding (maybe due to weaning, an infant sickness, or the infant sleeping for longer periods of time at night). Identifying the underlying issue is integral to finding the appropriate treatment.[12]
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Frequently asked questions
Breast engorgement occurs when the breasts are overfilled with milk and swollen, causing them to feel firm, tender, and painful. This can occur 3 to 5 days after delivering a baby, due to the onset of copious milk production (called primary breast engorgement), or at any time during the postpartum period when milk supply exceeds milk removal (called secondary breast engorgement). Strategies to manage and prevent engorgement are important because this condition increases the risk for breastfeeding problems like mastitis, clogged ducts, latching difficulties, infant feeding refusal, and premature cessation of breastfeeding.[1]
When the breasts are engorged with milk and swollen, some common signs and symptoms appear in one or (more often) both breasts. The breasts can feel firm, tender, tight, painful, warm, and even lumpy. They will look larger, can be uneven or lopsided, and the skin covering them may appear shiny (due to being stretched) and have more visible veins. The swelling sometimes extends to the armpit or across the sternum and can also affect the nipples, making them firm and flat (or even inverted).[2] Systemically, a mildly elevated body temperature may be present.[3] These signs and symptoms can ebb and flow, remain constant, or progressively worsen with time.[4] It is considered normal to experience some degree of breast engorgement in the first week after giving birth.[5]
Even though breast engorgement can be managed at home, it may be helpful to meet with a healthcare provider — particularly a lactation consultant — about the issue. A lactation consultant can assess breastfeeding or pumping technique and provide individualized strategies to better manage (and prevent future) engorgement. It is also important to contact a healthcare provider if the engorgement is not getting better despite treatment, if the infant is unable to latch or isn’t making enough wet diapers, if symptoms of mastitis are present (like a fever and body aches), or if there are additional concerns.[3]
Breast engorgement can affect the infant. Swollen breasts make latching onto the nipple difficult for infants, especially when the swelling involves the nipple and pulls it inward.[13] This can affect an infant’s willingness to breastfeed, as well as the amount of milk they receive. It can also contribute to nipple pain because the latch that is achieved is often shallow. When breast engorgement is caused by an oversupply of milk, infants can get too much milk too quickly. This can lead to frequent spit ups, lactose overload, explosive green stools, gassiness, fussiness, and coughing/choking at the breast.
Breast engorgement is a clinical diagnosis that is made based on the presenting signs and symptoms.[6] There is no test or imaging needed to make the diagnosis. If symptoms worsen or a fever develops, it is important to seek medical attention because breast engorgement can precede mastitis, clogged ducts, and other more serious conditions (like a breast abscess).[3]
Most of the treatments for breast engorgement can be done at home and are centered around effective removal of milk through frequent (but not excessive) breastfeeding or pumping with proper technique. Medical management usually isn’t required, especially for self-limiting cases of primary engorgement. Over-the-counter pain relievers, such as ibuprofen and acetaminophen, can be taken at the appropriate dose to reduce symptoms and improve comfort. These medications are safe to take while breastfeeding.[5] Antibiotics are not appropriate for breast engorgement, although they may be used to treat some cases of mastitis.
There are some medications that decrease milk supply, like decongestants (e.g., pseudoephedrine)[14] and certain combined oral contraceptives.[12] These medications are not commonly used in the context of breast engorgement because they could permanently reduce milk production (unless the goal is to halt lactation). Breast engorgement is better managed by effective milk removal coupled with supportive measures to reduce discomfort.
There is no evidence to support the use of oral supplements in the treatment of breast engorgement, but there are studies on the use of supplements to increase or decrease breast milk production, as found on the lactation page.
Sunflower lecithin is commonly used in the context of breast engorgement to prevent clogged milk ducts by making breast milk “less sticky”. However, there are no controlled trials to support this claim. Similarly, probiotics, specifically Lactobacillus salivarius and Lactobacillus fermentum, are sometimes used during breast engorgement to prevent mastitis, but high-quality evidence for this practice does not yet exist.[7][8]
Diet, including fluid intake, is unlikely to affect breast engorgement, and there are no studies linking diet to the presence or absence of breast engorgement. The volume of milk that a lactating parent produces is primarily driven by the amount of milk that is removed from the breasts,[9] not by the dietary choices of the parent.[10]
Frequent (but not excessive) removal of breast milk is the primary treatment for breast engorgement, which means either the infant or a pump must effectively drain milk from the breasts. If breastfeeding, there are some simple techniques to help an infant achieve better feeds from an engorged breast and thus treat the condition. Manual expression of small amounts of milk prior to beginning a feed can soften the breast and help the infant latch onto the nipple more easily. Just remember to keep the amount of expressed milk small because overstimulation will worsen the problem. Reverse pressure softening, pressing into the chest wall with 2 fingers on each side of the nipple, can also help an infant latch on by pushing fluid away from the nipple. If the engorgement is causing a strong let down (ejection of milk), breastfeeding in a reclined position can slow the flow of milk and improve infant feeding.[5][3]
Comfort measures are another important aspect of treating breast engorgement. One of the most common methods of reducing pain from engorgement is the use of cold compresses for 15 to 20 minutes between feedings. The compress can be an ice pack, a bag of frozen vegetables, cabbage leaves, or an herbal compress.[1] Heat, applied via a warm shower or warm pack, is sometimes used to facilitate milk removal; however, heat should be limited to only a few minutes immediately prior to a feeding because heat increases blood flow and can worsen breast swelling. Breast massage, acupuncture, and ultrasound therapies have also been used to treat breast engorgement, but there is limited evidence on their efficacy. Of the three methods, gentle massage is the most promising for symptom relief.[5] Additionally, wearing a well-fitting bra that is supportive but not overly tight can reduce discomfort.
For people who exclusively pump, the comfort measures used to treat breast engorgement are the same (e.g., pain medications, cold compress), but there are key differences in assessing the effective removal of milk from the breasts. Rather than assessing infant latch and feeding positions, pumping parents should assess the appropriateness of their pumping schedule (including frequency and duration of sessions per day) based on their infant’s age and needs and the condition and function of their pump and pump parts.[15] The pump should be providing adequate suction, the flanges should be the proper size, and all the pump parts should be replaced in accordance with the pump manufacturer’s guidelines or as needed. People who pump more frequently need to replace parts more often to maintain optimal suction.
Certain pumps also have different suction settings that can be adjusted throughout or between sessions to remove milk more effectively.[16] Some people experiment with these settings until they find a strategy that works best for them. Alternatively, a lactation consultant is an excellent resource for creating an individualized pumping plan.
Primary breast engorgement is caused by hormonal shifts that cue the production of copious amounts of milk, and these shifts are called lactogenesis II or the second stage of milk production. During this stage, there is a rapid drop in progesterone and a rise in prolactin, cortisol, and insulin, which stimulate breast milk to “come in” and replace colostrum (the “first milk”).[11] This sudden increase in milk production and interstitial fluid volume causes breast swelling and the signs and symptoms of engorgement. When no complications are present and feeding techniques are effective, it is a self-limiting condition that resolves within the first week postpartum as milk production regulates to match infant demand.[1]
Secondary breast engorgement occurs later in the postpartum period when there is a mismatch between milk production and milk removal.[3] There are a wide variety of reasons why this might happen, some related to the lactating parent, some to the infant, and some to both. Examples include a hormonal imbalance in the parent that increases milk production (like hyperthyroidism), pumping too frequently and stimulating excessive milk production, breastfeeding difficulties (like poor latch or positioning), and decreased infant feeding (maybe due to weaning, an infant sickness, or the infant sleeping for longer periods of time at night). Identifying the underlying issue is integral to finding the appropriate treatment.[12]
Primary breast engorgement is very common, affecting an estimated two-thirds of people within the first week postpartum. However, there is some evidence that primary breast engorgement is more likely or more severe in first pregnancies (primiparous), in people who are unable to breastfeed within the first hour after delivery or have difficulty breastfeeding (either for maternal or infant reasons), in people who experience premenstrual breast tenderness and engorgement, in people who have breast surgery or a lumpectomy, and in people who receive large amounts of intravenous fluids during labor.[5]
Breast engorgement cannot always be prevented, especially the engorgement that occurs shortly after giving birth when milk production increases (called primary engorgement). Nonetheless, there are some strategies that may reduce the risk of developing engorged breasts or the engorgement severity. For primary engorgement, early skin-to-skin contact, which involves placing the dry, naked newborn baby onto the parent’s bare chest shortly after delivery and ideally until the end of the first breastfeeding, is associated with less breast engorgement and breast pain, as is early and effective breastfeeding.[17] Parents who receive thorough breastfeeding education might also be less likely to experience primary engorgement, although the evidence on this intervention is mixed.[18][5]
For secondary engorgement, prevention involves avoiding a mismatch between milk supply and milk removal. Some strategies include not skipping feeding/pumping sessions, using proper breastfeeding or pumping techniques (e.g., ensuring a good latch, using the proper sized flange), feeding the baby on demand, avoiding breast pumping or expressing milk beyond the infant’s needs, wearing supportive but not overly tight bras, and dropping feeds slowly and gradually rather than abruptly when weaning the infant. If a parent and infant are having feeding difficulties, it is important to speak with a healthcare provider, preferably a lactation consultant.[5]
There are also certain breastfeeding techniques that may reduce the likelihood of engorgement. For example, people with an oversupply of milk may benefit from “block feeding”, in which the infant is fed from one breast for a set amount of time (maybe the first 3 to 6 hours of the day) before switching to the other breast for a set amount of time. By reducing stimulation to only one breast per feeding, breast milk production slows down, and engorgement is less likely.[12][19] Techniques like these are best used under the guidance of a lactation consultant or other qualified healthcare professional because they are not appropriate in every situation.
References
- ^Zakarija-Grkovic I, Stewart FTreatments for breast engorgement during lactation.Cochrane Database Syst Rev.(2020-Sep-18)
- ^Mass SBreast pain: engorgement, nipple pain and mastitis.Clin Obstet Gynecol.(2004-Sep)
- ^Gresh A, Robinson K, Thornton CP, Plesko CCaring for Women Experiencing Breast Engorgement: A Case Report.J Midwifery Womens Health.(2019-Nov)
- ^Humenick SS, Hill PD, Anderson MABreast engorgement: patterns and selected outcomes.J Hum Lact.(1994-Jun)
- ^Berens P, Brodribb WABM Clinical Protocol #20: Engorgement, Revised 2016.Breastfeed Med.(2016-May)
- ^Douglas PRe-thinking benign inflammation of the lactating breast: Classification, prevention, and management.Womens Health (Lond).(2022)
- ^Barker M, Adelson P, Peters MDJ, Steen MProbiotics and human lactational mastitis: A scoping review.Women Birth.(2020-Nov)
- ^Crepinsek MA, Taylor EA, Michener K, Stewart FInterventions for preventing mastitis after childbirth.Cochrane Database Syst Rev.(2020-Sep-29)
- ^Bendixen MM, Iapicca LC, Parker LANonpharmacologic Factors Affecting Milk Production in Pump-Dependent Mothers of Critically Ill Infants: State of the Science.Adv Neonatal Care.(2023-Feb-01)
- ^Minato T, Nomura K, Asakura H, Aihara A, Hiraike H, Hino Y, Isojima T, Kodama HMaternal Undernutrition and Breast Milk Macronutrient Content Are Not Associated with Weight in Breastfed Infants at 1 and 3 Months after Delivery.Int J Environ Res Public Health.(2019-Sep-09)
- ^Pang WW, Hartmann PEInitiation of human lactation: secretory differentiation and secretory activation.J Mammary Gland Biol Neoplasia.(2007-Dec)
- ^Johnson HM, Eglash A, Mitchell KB, Leeper K, Smillie CM, Moore-Ostby L, Manson N, Simon L,ABM Clinical Protocol #32: Management of Hyperlactation.Breastfeed Med.(2020-Mar)
- ^Westerfield KL, Koenig K, Oh RBreastfeeding: Common Questions and Answers.Am Fam Physician.(2018-Sep-15)
- ^Aljazaf K, Hale TW, Ilett KF, Hartmann PE, Mitoulas LR, Kristensen JH, Hackett LPPseudoephedrine: effects on milk production in women and estimation of infant exposure via breastmilk.Br J Clin Pharmacol.(2003-Jul)
- ^Meier PP, Patel AL, Hoban R, Engstrom JLWhich breast pump for which mother: an evidence-based approach to individualizing breast pump technology.J Perinatol.(2016-Jul)
- ^Jackson BA, Pawlowski CM, Weiner GM, Sturza J, Stanley KPInterchanging Breast Pump Kit Brands Alters Breast Pump Suction Pressure.Breastfeed Med.(2020-Feb)
- ^Elizabeth R Moore, Nils Bergman, Gene C Anderson, Nancy MedleyEarly skin-to-skin contact for mothers and their healthy newborn infantsCochrane Database Syst Rev.(2016 Nov 25)
- ^Huda MH, Chipojola R, Lin YM, Lee GT, Shyu ML, Kuo SYThe Influence of Breastfeeding Educational Interventions on Breast Engorgement and Exclusive Breastfeeding: A Systematic Review and Meta-Analysis.J Hum Lact.(2022-Feb)
- ^K Evans, R Evans, K SimmerEffect of the method of breast feeding on breast engorgement, mastitis and infantile colicActa Paediatr.(1995 Aug)
Examine Database References
- Pain - Kee WH, Tan SL, Lee V, Salmon YMThe treatment of breast engorgement with Serrapeptase (Danzen): a randomised double-blind controlled trialSingapore Med J.(1989 Feb)