Breast Engorgement: Causes, Treatments, and Complications

How to Deal with Hard, Swollen, Painful Breasts

Breastfeeding Newborn, Breast Engorgement.
Breast engorgement is a common breastfeeding problem, especially during the first few weeks. David Oliver/Getty Images

What Is Breast Engorgement?

Breast engorgement is the development of hard, swollen, painful breasts from too much breast milk. Engorged breasts can become extremely large, tight, lumpy, and tender. The swelling may go all the way up into your armpit, and the veins on the surface of your breasts may become more visible or even stick out.  

Breast Engorgement After the Birth of Your Baby

It's normal to have some degree of breast engorgement within the first week or two after the birth of your baby.

An increase in the blood flow to your breasts along with a surge in your milk supply may cause your breasts get too heavy and full. If you're breastfeeding, this stage of breast engorgement starts to get better within a few days as your milk production adjusts to meet your baby needs. 

If you aren't going to breastfeed, you'll still experience breast engorgement. Since your body doesn't know that you won't be breastfeeding, it will make breast milk. You'll begin to feel the fullness when your milk comes in between the 3rd and 5th day postpartum. If you don't remove the breast milk, your body will gradually stop making more. The uncomfortable, painful part of engorgement should only last a day or a few days, but you'll continue to make breast milk for a few weeks.

Breast Engorgement and Milk Fever

Breast engorgement during the first week or so of breastfeeding can be associated with a fever and an overall run-down feeling.

So, if you have an elevated body temperature that's not from an illness or infection, it could be from your milk coming in. This condition is sometimes called milk fever. 

You can continue to breastfeed with a fever. But, since a fever could also be a sign of a breast infection called mastitis, or another illness or infection, notify your doctor.

If it turns out it is not milk fever, the faster you catch and treat an infection, the better. 

Breastfeeding and Breast Engorgement

Breast engorgement is a common breastfeeding problem, and it isn't limited to the first few weeks. You may also experience engorgement at other times and for other reasons. For example, if you skip a feeding or miss a pumping session, you may begin to feel that heavy, fullness of engorgement. When it does happen, address it as soon as possible to prevent complications. If left untreated, engorgement can lead to potentially serious issues including painful blebs, plugged milk ducts, or mastitis. Difficulty breastfeeding and problems with your milk supply could also result.

The Causes of Breast Engorgement

Whenever breast milk builds up in your breasts, and it's not removed regularly or fully, swelling and firmness can develop. Breast engorgement is most often caused by one of the following situations:

How to Treat Breast Engorgement

Whatever the cause, the fullness and pressure of breast engorgement can be painful. Here's what you can do to treat it. 

  • Breastfeed your baby frequently. Offer your child the breast very often, at least every 1 to 3 hours throughout the day and night.
  • Let your child breastfeed for as long as she wants, but at least 20 minutes at each feeding.
  • If you have a sleepy baby, wake her up for feedings.
  • Use a hand expression technique or a breast pump to remove a little bit of breast milk before each feeding. It will help relieve some of the tightness, soften your breast, and make it easier for your baby to latch on.
  • Massage your breast as your baby nurses to help remove more milk.
  • After each feeding, place a cold compress or cabbage leaves onto your breasts. These items can provide some relief from the pain and swelling. 
  • Alternate breastfeeding positions to drain all the areas of your breasts.
  • Talk to your doctor about taking an over the counter pain medication such as Tylenol or Motrin to help ease the pain and inflammation.
  • Breastfeed from only one side for an entire feeding to help empty that breast fully. Then, start the next feeding on the opposite side.
  • Don't give your baby formula or water in between breastfeeding sessions. He'll take less breast milk when it's time to nurse, and you're more likely to become engorged.
  • Take a warm shower or apply a warm compress to your breasts just before breastfeeding. The warmth can help with your let-down reflex and get your milk flowing. But, you shouldn't put heat on your breasts between feedings since it can make the swelling worse.
  • Get plenty of rest.  
  • Watch for signs of blebs, plugged milk ducts, or a breast infection.
  • Contact your doctor, a lactation consultant, or a local La Leche League group to check your breastfeeding technique.
  • If you're weaning, try weaning more slowly. If you gradually wean your baby, you may not experience breast engorgement at all. 

The Complications of Breast Engorgement

A poor latch: If your breasts are overfull and hard, your nipples can become flat. Flat nipples and a hard breast make it tough for your baby to latch on. 

A low breast milk supply: If the swelling is not relieved, and your baby can't latch on, your breast milk will not be removed. When breast milk stays inside your breasts, it doesn't stimulate the production of more breast milk which can put your milk supply at risk. You can also end up with a low milk supply from the overuse of cold compresses and cabbage leaves.

Poor weight gain for your baby: If your child is having trouble latching on to your breast, he may not be able to get enough breast milk to gain weight in a healthy fashion.

A forceful flow of breast milk: The pressure from the backup of milk in your breasts can lead to an overactive let-down reflex and a very fast flow of breast milk out of your breasts. A hyperactive let-down or a fast flow of milk can cause your baby to gag, choke, and swallow excessive amounts of air as he's trying to gulp down the breast milk. 

Breast refusal: Your baby may become frustrated from a difficult latch, not getting enough breast milk or a very fast flow. These engorgement related problems can result in a nursing strike.

Breast problems: Breast engorgement can lead to other breast issues including sore nipples, blebs, plugged milk ducts, and mastitis.

Early weaning: Many women leave the hospital within a few days of childbirth, so breast engorgement often begins at home. Since it can be painful and cause difficulty with latching on and breastfeeding, it's a common cause of early weaning. 

How to Prevent Breast Engorgement While You're Weaning: 4 Tips

  1. If possible, wean your baby slowly. Gradual weaning helps to lower your supply of breast milk over a period a time which can prevent full, painful, swollen breasts.
  2. Wear a tight, supportive bra.
  3. Use ice packs or cabbage leaves to help reduce any swelling and decrease your milk supply.
  4. Remove a small amount of breast milk to relieve any pressure or discomfort that you may feel. But, be careful not to express too much or your body will continue to make more.

Sources:

Academy of Breastfeeding Medicine Protocol Committee. (2009). ABM clinical protocol# 20: Engorgement.

American Academy of Pediatrics. (2011). New Mother’s Guide To Breastfeeding. Bantam Books. New York.

Cadwell, Karin, Turner-Maffei, Cynthia, O'Connor, Barbara, Cadwell Blair, Anna, Arnold, Lois D.W., and Blair Elyse M. (2006). Maternal and Infant Assessment for Breastfeeding and Human Lactation A Guide for the Practitioner Second Edition. Jones and Bartlett Publishers.

Lawrence, Ruth A., MD, Lawrence, Robert M., MD. (2011). Breastfeeding A Guide For The Medical Profession Seventh Edition.  Mosby.

Riordan, J., and Wambach, K. (2014). Breastfeeding and Human Lactation Fourth Edition. Jones and Bartlett Learning.

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