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 breastfeeding 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 breastfeeding routine but cannot nurse or pump as much as usual.
- If you and your baby suddenly stop breastfeeding.
- When your baby's breastfeeding suddenly drops, either when your baby is starting or increasing solid foods or when the baby is ill with a poor appetite.
As you get close to your due date, your breasts make colostrum. Colostrum is a yellowish liquid that contains important nutrients and antibodies that a baby needs right after birth. About 2 to 5 days after your baby is born, your breasts start making milk for your baby. 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 breastfeeding 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 breastfeed 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 breastfeeding 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 breastfeed 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 breastfeed 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?
- 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 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 breastfeeding, take care not to let your breasts become overfilled.
- Breastfeed 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, and your milk supply will stay 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 breastfeed.
How is breast engorgement diagnosed?
Breast engorgement is diagnosed based on symptoms alone. No examinations 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 breastfeeding). 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.
Apply ice or cold compresses, and wear a supportive nursing bra that is not too tight.
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 breastfeeding, 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
Learning about breast engorgement:
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.
- 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.
- The lymph nodes in your armpits may be slightly swollen and tender.
Complications of engorgement
If you are breastfeeding and don't relieve breast engorgement, you are likely to develop one or both of the following:
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 38.5°C (101°F) or higher.
Call your doctor today if you have:
- Swollen glands (lymph nodes) in the neck or armpit.
- A fever less than 38.5°C (101°F).
Call your doctor if you have cracked and bleeding nipples after trying home treatment for 24 hours.
Examinations and Tests
No examinations or tests are needed to diagnose breast engorgement. If your doctor suspects a breast infection (mastitis), you will be treated with antibiotics.
For more information, see the topic Mastitis While Breastfeeding.
Breast engorgement is a common problem after birth and during breastfeeding. You can prevent and treat it at home. You do not need to visit your doctor unless you have symptoms of an infection (mastitis), which may require antibiotic treatment.
If you are not going to breastfeed, 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 breastfeeding, self-care focuses on increasing the flow of milk out of your breasts. You do this with frequent breastfeedings, 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 breastfeeding, 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 Home Treatment.
To prevent severe breast engorgement
If you are planning to breastfeed, do the following to prevent severe breast engorgement.
- Start breastfeeding as soon as possible
after your baby is born, and continue to breastfeed often. This is the best way to prevent
- In the first few days after birth, breastfeed 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 breastfeed.
- 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 with a pump. Then put your
baby to the breast. You can also:
- Take a warm shower, letting the water flow over your breasts. This should trigger the let-down reflex, which allows some milk to leak out and also slightly softens the nipple and areola.
- Place warm, moist towels on your breasts before breastfeeding. The moist heat should help your milk flow more easily.
- Empty your breasts with each feeding.
- Your baby should breastfeed for as long as he or she wants. In general, it's best if this is for 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, use a pump or use your hands (manual expression) to squeeze the remaining milk from your breasts to store for later use. This is especially important during the early stages of breastfeeding.
- Early engorgement will decrease as breastfeeding becomes more routine and your baby is able to feed for longer periods of time.
- Change your baby's breastfeeding position now and then to make sure that all parts of your breasts are emptied. For information on breastfeeding positions, see the topic Breastfeeding.
- 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. View a slideshow of proper latch-on for breastfeeding.
- Anytime you are not able to breastfeed your baby, arrange for a time and place to manually express or pump milk from your breasts at least every 3 to 4 hours.
Discuss any breastfeeding problems or concerns with your doctor or a breastfeeding specialist (lactation consultant).
To relieve breast engorgement
If you need to breastfeed 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
breastfeeding, to avoid nipple damage. When the nipple and areola are soft,
the nipple protrudes more easily, allowing your baby to latch on well. View a
slide show of
proper latch-on for breastfeeding.
- If your breasts are freely leaking, you can use a warm compress for a couple of minutes before breastfeeding.
- Gently pump or use your hands (manual expression) to let out 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.
- Breastfeed your baby more often, or pump your breasts if your baby won't breastfeed. 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 breastfeeding:
- 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.
- Avoid constricting bras that press on your breasts. A tight bra can reduce milk flow through the ducts, eventually causing blocked ducts.
To relieve engorgement if you are not breastfeeding
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 Advil or Motrin) in addition to the non-medicine treatments. Be safe with medicines. Read and follow all instructions on the label.
- 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.
- Wear a supportive bra that fits well.
Other Places To Get Help
- Lawrence RM, Lawrence RA (2009). The breast and physiology of lactation. In RK Creasy et al., eds., Creasy and Resnik's Maternal-Fetal Medicine, 6th ed., pp. 125-142. Philadelphia: Saunders Elsevier.
Other Works Consulted
- American Academy of Pediatrics (2009). Feeding your baby: Breast and bottle. In SP Shelov et al., eds., Caring For Your Baby And Young Child: Birth to Age 5, 5th ed., chap. 4, pp. 91-93. New York: Bantam.
- Cunningham FG, et al. (2010). The puerperium. In Williams Obstetrics, 23rd ed., pp. 646-660. New York: McGraw-Hill.
Adaptation Date: 6/19/2018
Adapted By: HealthLink BC
Adaptation Reviewed By: HealthLink BC
Adaptation Date: 6/19/2018
Adapted By: HealthLink BC
Adaptation Reviewed By: HealthLink BC
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