Engorged Breasts

Breasts that are over full or engorged with milk can feel swollen, hot, lumpy and painful. If the milk is not removed by your baby or by hand expression or a pump, engorged breasts can lead to mastitis (painful breast inflammation). It’s normal to have some engorgement when your milk first comes in but it can also happen unexpectedly at other times.

Breasts full and tender after the birth

Many mothers will have some engorgement in the early days or weeks after birth. As the milk “comes in”, extra blood and tissue fluids also come to the breasts to help with milk production. This causes congestion and swelling for a while. The fluid in the breasts may be worsened if you had an intravenous (IV) drip during the birth and can take some time to clear.

Engorged breasts after the first few weeks

Although engorgement is very common in the first few weeks of your baby’s life, it can happen at any time. Possible causes include;

  • your baby sleeping longer than expected
  • a missed feed
  • a blocked milk duct
  • feeding a baby on a schedule
  • baby not draining the breasts properly
  • weaning too quickly
  • tight clothing or a tight bra pressing on the breast
  • pumping more milk than your baby needs

Anything that interferes with breastfeeding on demand can increase your risk of engorgement and mastitis. Whatever the reason, and you may not be sure why, emptying engorged breasts by regular breastfeeds and with gentle massage or breast compressions will make sure they are drained thoroughly so that you feel comfortable again. If your baby can’t keep up with the milk, you may need to hand express or pump instead for a while.

Relieving engorgement

Breastfeeding your baby frequently, hand expressing or pumping, and gentle breast massage can all help with milk release and anti-inflammatory medication will provide pain relief when needed. Seven tips for relieving engorgement include:

#1 Breastfeed often

To help with engorgement, breastfeed often—at least 8 to 12 times in 24 hours. Try to get your baby’s latch (the way your baby attaches to the breast) and positioning as good as possible so that the breast milk is removed from the breast thoroughly. During breastfeeding or pumping, some gentle massage of the engorged areas and breast compressions can help to release more milk. If the engorgement has changed the shape of the nipple making it difficult for your baby to latch, see #4 below.

#2 Hand express to comfort if needed

If your baby can’t breastfeed or isn’t feeding well yet, you will need to hand express frequently to remove the milk while you seek some good breastfeeding help. Any expressed milk can be given to your baby until he is able to breastfeed. A pump may attract more swelling to the area in the early days before your milk is in properly. If you do use a pump, keep the suction at its lowest setting. Expressing your milk won’t make the engorgement worse. It is important to remove enough milk to feel comfortable, this will protect your milk supply in the days to follow and will help avoid blocked ducts or mastitis. Expressing a little milk may also make it easier for your baby to latch deeply. See Engorgement Relief When Milk Won’t Flow for more ideas if you are unable to get milk flowing.

#3 Gentle massage and hand expression

A technique popularised by Maya Bolman of Breastfeeding Medicine of Northeast Ohio called Therapeutic Breast Massage in Lactation (TBML) involves alternating gentle breast massage with hand expression (see video). This type of gentle massage can also help drain tissue fluid from the breast via the lymphatic system in the armpits.

#4 Reverse pressure softening

If your breasts are so full and engorged that your baby can’t latch on, a technique called reverse pressure softening can help. Reverse pressure softening can bring out a nipple flattened by severe engorgement by redistributing the extra fluid away from the nipple area. Jean Cotterman explains more about the technique in the article below. Gently hand expressing a little milk before feeding may also help soften the areola.

#5 Cold therapy

Cold compresses (e.g. frozen peas or crushed ice in a damp cloth) placed against any sore areas for up to 20 minutes at a time, or chilled cabbage leaves 12 in your bra can help reduce inflammation between feeds. Any particularly painful or red areas appearing on the breast could be signs of mastitis (breast inflammation) so be aware of Mastitis Symptoms and Treatment and when to get help.

#6 Pain relief

If the engorgement is very painful, appropriate pain relief or anti-inflammatory medication can help with the pain and inflammation.

#7 Gravity and green cabbage!

The Womanly Art of Breastfeeding, a popular breastfeeding book, has the following additional tips:

    • Moving your breasts gently may help drain lymph fluids. Massage them gently, lift them, move them around in ways that don’t hurt.
    • Lie flat on your back when you rest. Gravity will help drain fluids away from your breasts.
    • Part of engorgement is inflammation. Ask your doctor for an anti-inflammatory medicine that’s compatible with breastfeeding (most over-the-counter brands are).
    • Use green cabbage (red can stain), which may help reduce swelling [Stop use if a skin rash or other signs of allergy appear]. Remove the outer leaves in case there are any pesticides on them. Tear off some inner leaves, tear out the hard central stem, crumple the leaves gently in your hand, and apply them to your breast (not over your nipple, so the taste isn’t left behind to bother your baby). Doesn’t that feel wonderful? You can wear them inside a bra or under a tight shirt to keep them in place. replace the leaves with fresh ones whenever you want to.
    • Inflammation responds best to cold. Wrap a bag of frozen peas (or carrots) in a small towel and use it as a cold compress, alternating about twenty minutes on and twenty minutes off, as much as you like. Refreeze as needed. If you feel like a hot shower, let the water play over your back, not your chest. Same for a heating pad.
    • If engorgement returns, try expressing as much as you can from both sides, getting right down to the “bottom of the barrel.”

Lumps in the armpit

As breast tissue extends into the armpit (called the Tail of Spence) you may experience engorgement there too in the form of a lump in the armpit. Engorgement here will respond to the same measures used for engorgement in other areas of the breast such as careful breast drainage, gentle massage and cold therapy. Occasionally the lump in the armpit will be swollen glandular tissue that does not drain into the rest of the breast; cold compresses will help this to resolve. Note: extra milk making glandular tissue can also be found in other parts of the body on the ‘milk line’ 3.

Summary

Breasts that are over full with milk are known as engorged. Engorgement in the early weeks may also include blood and tissue fluid in the breast as well as breast milk. If engorgement is left unchecked it could develop into painful mastitis (inflammation of the breast). Feeding your baby frequently, or expressing your milk by hand expressing or pumping to keep your breasts comfortable is the best way to reduce engorgement and avoid mastitis. If you are having trouble expressing any milk see Engorgement Relief When Milk Won’t Flow. If you do develop symptoms of mastitis and are not starting to feel better after 12-24 hours of treatment, contact your health professional for advice. See Mastitis Symptoms and Treatment for further information.

*Extract reproduced by permission from Pinter & Martin

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