Condition Basics

What is breast engorgement?

Breast engorgement means your breasts are painfully overfull of milk. This usually occurs when you are making more milk than your baby uses. Your breasts may become firm and swollen, which can make it hard for your baby to breastfeed.

What causes it?

Engorgement may happen:

• When your milk first comes in, during the first few days after birth.
• When you have a regular breastfeeding routine but can't breastfeed or pump as much as usual.
• If you suddenly stop breastfeeding.
• When your baby suddenly starts breastfeeding less than usual. This may happen when your baby is starting or increasing solid foods or when your baby is ill and has a poor appetite.

Your breasts start making milk about 2 to 5 days after your baby is born. (Before that, they make colostrum, which contains important nutrients that your baby needs right after birth.) It's normal for your breasts to feel heavy, warm, and swollen when your milk "comes in." This early breast fullness is from 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.

This normal breast fullness will probably go away in a few days as you breastfeed and your body adjusts to your baby's needs.

Your breasts will be engorged for several days if you don't or can't breastfeed after your baby is born. This will gradually go away if your breasts are not stimulated to make milk. At present, there is no approved medicine to "dry up" your milk supply and prevent engorgement.

If you have any concerns or questions you can talk to your doctor or midwife or you can work with a lactation consultant. This is someone who helps with breastfeeding.

What are the symptoms?

Symptoms of engorged breasts include:

• Swollen, firm, and painful breasts. If the breasts are severely engorged, they are very swollen, hard, shiny, warm, and slightly lumpy to the touch.
• Flattened nipples. The dark area around the nipple, the areola, may be very firm. This makes it hard for your baby to latch on.
• A slight fever of around 100.4 °F (38 °C).
• Slightly swollen and tender lymph nodes in your armpits.

What if breast engorgement gets worse?

If engorgement is severe, your breasts get very swollen and painful. Severe engorgement can make it hard for your baby to latch on to the breast properly. As a result:

• Your baby may not get enough milk.
• Your breasts may not empty well.
• Your nipples may become sore and cracked. This may cause you to breastfeed less, and that makes the engorgement worse.

Engorgement can lead to blocked milk ducts and breast inflammation, which is called mastitis. Mastitis needs to be treated with regular breastfeeding, self-care, and sometimes antibiotics.

How can you care for yourself?

• Try taking ibuprofen (Advil, Motrin) to reduce pain and swelling. Or you can take acetaminophen (Tylenol) to help with discomfort. Be safe with medicines. Read and follow all instructions on the label.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• If your breasts hurt and feel too full, try hand expressing a small amount of milk just until they feel comfortable. But don't try to empty your breasts all the way. Releasing a lot of milk will cause your body to produce larger amounts of milk. This can make breast engorgement worse.
• If you are breastfeeding, continue to regularly breastfeed when your baby is hungry.
  • Change your breastfeeding positions to help remove milk from all areas of your breast.
  • If your baby is having trouble latching, try hand expressing a small amount of milk before feeding. This can help soften your breasts to make it easier for your baby to latch.
  • If you have any problems with your baby's latch or breastfeeding, talk to your doctor or midwife or a lactation consultant.
• Try using a cold compress for pain and swelling.Put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
• Wear a supportive bra that fits.
• Avoid massaging your breasts. This can cause tissue injury and inflammation.

How can you prevent breast engorgement?

You may be able to prevent engorgement if you keep milk moving out of your breasts and take care not to let your breasts become overfilled.

• Breastfeed whenever you notice signs that your baby is hungry, such as eagerly sucking on fingers or rooting. During the first few days and weeks, your baby will breastfeed at least 8 times in a 24-hour period.
• Make sure that your baby is latching on and feeding well. If your breasts are hard and overfilled, let out (express) enough to soften your nipples before putting your baby to the breast.
• Breastfeed on both breasts at each feeding. You can tell that it's time to switch sides when both of the following things happen:
  • Your baby's sucking slows down a lot or stops.
  • You can no longer hear your baby swallowing.