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. This article describes ways to help with engorgement.

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, even during weaning. 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. And if painfully engorged breasts are neglected this puts a mother at risk of having blocked ducts or mastitis. Whatever the reason for your overly full breasts, and you may not be sure why, emptying engorged breasts by regular breastfeeds, and trying gentle massage or breast compressions can help you feel comfortable again. If your baby can’t keep up with the milk volume, you may also need to hand express or pump for a while.

Relieving engorgement

Eight tips for relieving engorgement at any time include:

#1 Breastfeed often

Frequent breastfeeds can help relieve engorgement. Breastfeeding every couple of hours or at least 8 to 12 times in 24 hours gives your baby lots of opportunity to remove the milk that is building up. Conversely, going long periods without removing milk will increase the discomfort. If your baby can breastfeed well, this will usually be more efficient than using a breast pump.

#2 Check positioning and attachment

The way a baby attaches to the breast (latch) and the way they are held to breastfeed (positioning) can help or hinder milk removal. When a baby has a big mouthful of breast tissue as well as the nipple they are more likely to drain the breast more thoroughly. If breastfeeding is not comfortable ask a breastfeeding specialist to check your positioning and attachment and see Latching Tips, Breastfeeding Positions for Newborns and Why Does Breastfeeding Hurt?  Trying different breastfeeding positions to usual can be helpful to relieve areas of the breast that are engorged and seem difficult to drain. If the engorgement has changed the shape of the breast and nipple making it difficult for your baby to latch, see #5 below.

#3 Breast massage

Massaging engorged areas of the breast both before and during breastfeeding (or pumping) can help milk to flow. Two variations of this are explained below.

Therapeutic Breast Massage

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 armpits1.

Breast compression

Breast compression involves applying pressure to the milk-making tissue in the breast to help milk flow. During a breastfeed, applying a little pressure to particularly engorged areas with a free hand can help to release more milk from that area. Breast compression is explained more fully in What is Breast Compression? 

#4 Hand express or pump to comfort if needed

If your baby can’t breastfeed, isn’t feeding well yet, or can’t keep up with the volume of milk, you will need to remove enough milk to stay comfortable by other means than breastfeeding.

  • Hand expression. Frequent hand expressing is a good way to remove excess breast milk in the early days after birth, see Hand Expressing Breast Milk. for videos and further information. A pump may attract more swelling to the area before your milk is in properly by pulling more blood or tissue fluid towards the nipple. If you do use a pump at this time, keep the suction at its lowest setting.
  • Pumping. Pumping with a good quality breast pump can help to keep the breasts comfortable if they are engorged after your milk has “come-in”. If you still feel engorged after a breastfeed, a breast pump can remove enough milk until you feel comfortable.
  • When milk won’t flow. See Engorgement Relief When Milk Won’t Flow for more ideas if you are unable to get milk flowing.
  • Keep baby well fed. If your baby is not latching, any expressed milk can be given to your baby to keep him well fed until you can find some good breastfeeding help.

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.

#5 Help baby to latch

If your breasts are extremely full and engorged they may feel very tight and sometimes your nipples may seem to flatten out and disappear. When this happens it can be difficult for a baby to latch on. When engorgement is preventing a baby from latching on, it can help to move some of the milk away from directly behind the nipple either by hand expressing or a technique known as reverse pressure softening.

Hand expression

Gently hand expressing a little milk before feeding can help soften the breast around the nipple so that baby can latch. See Hand Expressing Breast Milk. for videos and further information

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 temporarily redistributing the extra fluid away from the nipple area back into the breast. Jean Cotterman explains more about the technique in the article below.

#6 Cold therapy and cabbage

Cold compresses (e.g. frozen peas or crushed ice in a damp cloth) placed against any sore areas of the breast for up to 20 minutes at a time, or chilled cabbage leaves 23 in your bra can help reduce inflammation between feeds. The Womanly Art of Breastfeeding, a popular breastfeeding book, explains more about cabbage and cold therapy:

  • 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.

Cold or heat?

Some experts recommend placing warm towels on the breast just before pumping (or breastfeeding) as a little warmth can help with the let-down reflex. It’s important not to go too warm as too much heat can bring more blood to the area and make the engorgement worse.

#7 Pain relief

If engorgement is very painful, appropriate pain relief or anti-inflammatory medication can help with the pain and accompanying inflammation. Pain relief may also help the let-down reflex 4. Note that 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.

#8 Gravity

The Womanly Art of Breastfeeding suggests lying flat on your back to rest allows gravity to help drain fluids away from the breasts 5

What to do about breast pain—video

The following video by Global Health Media summarises the steps to take to relieve engorgement

Lumps in the armpit

Breast tissue extends into the armpit (called the Tail of Spence). It is possible therefore for this breast tissue to become engorged 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’ 6.

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). Breastfeeding frequently, hand expressing or pumping to stay comfortable, and gentle breast massage can all help to reduce breast 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