Breast Engorgement


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?

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 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.

To soften your breasts before feedings, apply heat, massage gently, and use your hands or use 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 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.


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: 11/6/2019

Adapted By: HealthLink BC

Adaptation Reviewed By: HealthLink BC

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