Breast Engorgement

Topic Overview

What is breast engorgement, and what causes it?

Breast engorgement is the painful overfilling of the breasts with milk. This is usually caused by an imbalance between milk supply and infant demand. This condition is a common reason that mothers stop breast-feeding sooner than they had planned.

Engorgement can happen:

• When milk first "comes in" to your breasts, during the first few days after birth.
• When you normally have a regular breast-feeding routine but cannot nurse or pump as much as usual.
• If you and your baby suddenly stop breast-feeding.
• When your baby's breast-feeding suddenly drops, either when your baby is starting or increasing solid foods or when the baby is ill with a poor appetite.

Your breasts start making milk for your baby about 2 to 5 days after your baby is born. When your milk comes in, your breasts will most likely feel warm and heavy. Some women feel only slight swelling. Others feel uncomfortably swollen.

Early breast fullness is completely normal. It occurs as your milk supply develops and while your newborn has an irregular breast-feeding routine. The normal fullness is caused by the milk you make and extra blood and fluids in your breasts. Your body uses the extra fluids to make more breast milk for your baby.

If you don't breast-feed after your baby is born, you will have several days of mild to moderate breast engorgement. This gradually goes away when the breasts are not stimulated to make more milk.

Overfilled breasts can easily become very swollen and painful, leading to severe engorgement. Common causes of severe engorgement are:

• Waiting too long to begin breast-feeding your newborn.
• Not feeding often enough.
• Small feedings that do not empty the breast well. Babies who are fed formula or water are less likely to breast-feed well.

Severe engorgement can make it difficult for your baby to latch on to the breast properly and feed well. This can make the problem worse. As a result:

• Your baby may not receive enough milk.
• Your breasts may not empty completely.
• Your nipples may become sore and cracked. This is caused by your baby's attempts to latch on to your overfull breasts. If you then breast-feed less because your nipples are sore, the engorgement will increase.

Without treatment, severe engorgement can lead to blocked milk ducts and breast infection, which is called mastitis.

What are common symptoms of breast engorgement?

Engorged breasts:

• Are swollen, firm, and painful. If severely engorged, they are very swollen, hard, shiny, warm, and slightly lumpy to the touch.
• May have flattened-out nipples. The dark area around the nipple, called the areola, may be very hard. This makes it difficult for your baby to latch on.
• Can cause a slight fever of around 100 °F (37.8 °C).
• Can cause slightly swollen and tender lymph nodes in your armpits.

How can you prevent breast engorgement?

You can prevent breast engorgement by closely managing the milk your breasts make and keeping milk moving out of your breasts. During your body's first week or two of adjusting to breast-feeding, take care not to let your breasts become overfilled.

• Breast-feed your baby whenever he or she shows signs of hunger. If your breasts are hard and overfilled, let out (express) enough to soften your nipples before putting your baby to the breast.
• Make sure that your baby is latching on and feeding well.
• Empty your breasts with each feeding. This will help your milk move freely, keeping your milk supply at the level your baby needs.

If you have any concerns or questions, this is a good time to work with a lactation consultant, someone who helps mothers learn to breast-feed.

How is breast engorgement diagnosed?

Breast engorgement is diagnosed based on symptoms alone. No exams or tests are needed.

How can you treat breast engorgement?

A few days after your milk comes in, your milk supply should adjust to your baby's needs. You can expect relief from the first normal engorgement within 12 to 24 hours (or in 1 to 5 days if you are not breast-feeding). Your symptoms should disappear within a few days. If not, or if your breasts do not soften after a feeding, start home treatment right away.

To reduce pain and swelling, take ibuprofen (such as Motrin or Advil), apply ice or cold compresses, and wear a supportive nursing bra that is not too tight.

To soften your breasts before feedings, apply heat, massage gently, and use your hands or a pump to let out (express ) a small amount of milk from both breasts.

If your baby can't feed well or at all (such as during an illness), be sure to gently pump enough to empty each breast. You can store or freeze the breast milk for later use.

If your breasts still feel uncomfortable after nursing, apply cool compresses.

If you are not breast-feeding, avoid stimulating the nipples or warming the breasts. Instead, apply cold packs, use medicine for pain and inflammation, and wear a supportive bra that fits well.

Frequently Asked Questions

Symptoms

Symptoms of breast engorgement happen when the breasts produce and fill with milk but little milk is removed from them. Milk overfills and engorges the breasts.

If your breasts are engorged, you may notice the following:

• Breasts are swollen, firm, and painful. If severely engorged, breasts are very swollen, hard, shiny, warm, and slightly lumpy to the touch.
• Your nipple may flatten out and the dark area around the nipple, called the areola, may be very hard.
  • Your baby may have trouble latching on to a flattened, hard nipple and may not be able to get enough milk out. See a picture of proper latch-on for breast-feeding .
  • If your baby is not able to get enough milk, he or she will suck harder than usual during nursing and want to nurse more often.
  • Your nipples may become damaged by your baby's efforts to latch on well and get enough milk.
• You have a slight fever of around 100 °F (37.8 °C).
• The lymph nodes in your armpits may be slightly swollen and tender.

Complications of engorgement

If you are breast-feeding and don't relieve breast engorgement, you are likely to develop one or both of the following:

• Blocked milk duct
• Breast infection, called mastitis. (See a picture of mastitis .)

Call your doctor now if you have:

• Increasing pain in one area of the breast.
• Increasing redness in one area of the breast or red streaks extending away from an area of the breast.
• Drainage of pus from the nipple or another area of the breast.
• A fever of 101 F (38.5 C) or higher.

Call your doctor today if you have:

• Swollen glands (lymph nodes) in the neck or armpit.
• A fever less than 101 F (38.5 C).

Call your doctor in 24 hours if you have cracked and bleeding nipples after trying home treatment.

See help for blocked milk ducts and breast infection (mastitis). For more information, see the topic Mastitis While Breast-Feeding.

Exams and Tests

No exams or tests are needed to diagnose breast engorgement. If your health professional suspects a breast infection (mastitis), you will be treated with antibiotics.

Sometimes, a sample of breast milk is tested (cultured) to diagnose the type of bacterial infection. For more information, see the topic Mastitis While Breast-Feeding.

Treatment Overview

Breast engorgement is a common problem after birth and during breast-feeding. You can prevent and treat it at home. You do not need to visit your health professional unless you have symptoms of an infection (mastitis), which may require antibiotic treatment.

If you are not going to breast-feed, there currently is no safe medicine available for "drying up" your breasts and preventing breast engorgement.

You can use self-care measures to help prevent or relieve breast engorgement.

• If you are breast-feeding, self-care focuses on increasing the flow of milk out of your breasts. You do this with frequent breast-feedings, making sure that your baby is latched on well. You can expect some relief within 12 to 24 hours, and the discomfort should disappear within a few days.
• If you are not breast-feeding, breast engorgement will improve as your breasts stop producing milk. Pain and discomfort should go away in 1 to 5 days. You may find home treatment helpful for relieving symptoms.

For more information on self-care measures to help prevent or relieve the discomfort of breast engorgement, see the Home Treatment section of this topic.

Home Treatment

To prevent severe breast engorgement

If you are planning to breast-feed, take the following measures to prevent severe breast engorgement.

• Start breast-feeding as soon as possible after your baby is born, and continue to breast-feed often. Offer your baby the breast every 1 to 2 hours while you are awake. This is the best way to prevent severe engorgement.
  • In the first few days after birth, breast-feed at least every 1 to 2 hours. Short periods of time between feedings may help reduce or prevent severe breast engorgement. During this time, you may have to wake your baby to breast-feed.
  • Feed your baby whenever he or she is hungry or at least every 2 hours.
• Make sure that your breasts are soft enough for your baby to latch on well. If your breasts are hard and too full of milk, let out (express) a small amount of milk with your hands or a pump. Then put your baby to the breast.
• Empty your breasts with each feeding.
  • Your baby should breast-feed at least 15 minutes or more on the first breast before changing to the second breast. You will know it is time to move to the other breast when your baby becomes less eager to suck.
  • If your baby becomes full before your breasts are empty, pump or use your hands to squeeze (manually express) the remaining milk from your breasts to store for later use. This is especially important during the early stages of breast-feeding.
  • Early engorgement will decrease as breast-feeding becomes more routine and your baby is able to feed for longer periods of time.
• Change your baby's breast-feeding position occasionally to make sure that all parts of your breasts are emptied. For information on breast-feeding positions, see the topic Breast-Feeding.
• Make sure your baby is latched on properly. If your nipples are flat, gently massage the nipple and areola. This should stimulate your nipple to become more erect. Then gently support your breast with your thumb on top and fingers underneath. This added support will make it easier for your baby to latch on. See a picture of proper latch-on for breast-feeding .
• Discuss any breast-feeding problems or concerns with your health professional or a breast-feeding specialist (lactation consultant).

When your baby is breast-feeding well, help prevent future breast engorgement problems by doing the following:

• If your breasts are becoming overfull, take a warm shower, letting the water flow over your breasts. This should trigger the let-down reflex, allowing some milk to leak out and slightly softening the nipple and areola. Remove excess milk and relieve pressure with pumping or by hand (manual expression) .
• If your milk is not flowing well and you are becoming overfull, place warm, moist towels on your breasts before breast-feeding. The moist heat should help your milk flow more easily.
• Anytime you are not able to breast-feed your baby, arrange for a time and place to manually express or pump milk from your breasts at least every 3 to 4 hours.
• When you and your baby are ready to wean, gradually stop breast-feeding over a period of several weeks. Start by dropping the least favorite breast-feeding time. Wait a few days until your supply decreases, then drop another feeding, and so on. Gradual weaning is best for both you and your baby. It gives your breasts time to adjust gradually to your baby's decreasing demand, and it gives your baby time to develop new eating patterns. For more information, see the topic Weaning.

To relieve breast engorgement

If you need to breast-feed but breast engorgement is preventing you from doing so, use these steps to keep your milk flow going and relieve your pain and swelling:

• Soften your nipple and areola before breast-feeding, to avoid nipple damage. When the nipple and areola are soft, the nipple protrudes more easily, allowing your baby to latch on well. See a picture of proper latch-on for breast-feeding .
  • If your breasts are freely leaking, you can use a warm compress for a couple of minutes before breast-feeding.
  • Gently pump or use your hands to squeeze (manually express) a small amount of milk. Be careful not to injure your breast tissue. An automatic cycling breast pump with the suction adjusted to low is best for relieving engorgement.
• Use gentle breast massage to promote milk flow.
• Breast-feed your baby more often, or pump your breasts if your baby won't breast-feed, to relieve symptoms of engorgement. Take care to empty your breasts each time. You can freeze pumped milk in clean containers or bags for later use.
• Reduce swelling and relieve pain. After breast-feeding:
  • Take a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil or Motrin, for example), in addition to the nonmedicine treatments. When taken as directed, ibuprofen is safe to use while breast-feeding.¹
  • Try cold compresses. Apply a frozen wet towel, cold gel or ice packs, or bags of frozen vegetables to your breasts for 15 minutes at a time every hour as needed. To prevent tissue damage, do not apply cold to your bare skin. Place a thin cloth between the cold pack and your skin.
  • Try raw cabbage leaves. Cover each breast with a cabbage leaf inside your bra. Change when wilted or after 2 hours. Some women find them helpful. But you may notice a slight drop in your milk supply.²
• Avoid constricting bras that press on your breasts. A tight bra can reduce milk flow through the ducts, eventually causing blocked ducts.

If you are bottle-feeding formula and you experience breast engorgement after childbirth, use one or more of the following measures to help relieve discomfort:

• Avoid pumping or removing a large amount of milk from your breasts. This stimulates milk production and makes engorgement worse. Remove just enough milk to make you feel more comfortable.
• Take ibuprofen (such as Motrin or Advil) in addition to the nonmedicine treatments.
• Try cold compresses. Place a frozen wet towel, cold gel or ice packs, or bags of frozen vegetables on your breasts for 15 minutes at a time every hour as needed. To prevent tissue injury, do not apply cold directly to bare skin. Place a thin cloth between the cold pack and your skin.
• Try raw cabbage leaves. Cover each breast with a cabbage leaf inside your bra. Change when wilted or after 2 hours. Constant use of cabbage leaves is thought to help reduce milk production.²
• Wear a supportive bra that fits well.

Other Places To Get Help

Organizations

Related Information

• Breast-Feeding
• Mastitis While Breast-Feeding
• Weaning

References

Citations

1. Lawrence RM, Lawrence RA (2004). The breast and physiology of lactation. In RK Creasy, R Resnik, eds., Maternal-Fetal Medicine, 5th ed., pp. 135-153. Philadelphia: Saunders.

2. Smith MK (2000). New perspectives on engorgement. LEAVEN, 35(6): 134-136.

Credits