Breast Engorgement

What is breast engorgement?

Breast engorgement (also called early postpartum engorgement) is swelling of your breasts that occurs soon after giving birth. It happens as your body shifts from the first stage of lactation (which starts during pregnancy) to the second stage. The second stage begins just a few days after delivery, and it’s when your milk starts “coming in.” Your body prepares to ramp up milk production by sending more blood and lymph to your breasts. This leads to an increased volume of fluid in between your breast tissues, which can cause pain and other symptoms.

The good news is that early postpartum engorgement is temporary. It typically peaks (has the worst symptoms) around five days after delivery. By the time you’re at two weeks postpartum, engorgement usually eases. Following tried-and-true methods can ease discomfort during this time.

What does an engorged breast feel like? 

When you have engorged breasts, you may notice:

• Swelling of both breasts, especially in the lower areas (farthest from your chest).
• Pain in your breasts, sometimes severe.
• Breasts that feel firm or hard.
• Less commonly, sweating, fever and chills.

These changes typically start about three to five days after giving birth. In some cases, engorgement doesn’t begin until postpartum day nine or 10. Engorgement can also happen any time there’s a mismatch between the amount of milk being produced and removal of that milk. This is why it’s more common in those who pump, as you’re not relying on your baby to tell you when to remove milk.

While your breasts are engorged, it might be difficult for your baby to latch on for breastfeeding.

You might think you have an infection if you have a fever or chills. But that’s often not the case. It’s possible to have these symptoms simply due to inflammation in your breasts, which can have systemic (entire body) effects. However, inflammatory or bacterial mastitis (when inflammatory mastitis progresses to an infection) can cause similar symptoms. But mastitis typically develops over days and is associated with warmth and redness of the breast.

That’s why it’s important to see a healthcare provider if you notice any changes in your breasts. They’ll find the cause and help you manage it appropriately.

Breast engorgement vs. hyperlactation

Hyperlactation, also called oversupply, is when your body makes more milk than your baby or babies need. Engorgement can be a symptom of hyperlactation, but engorgement doesn’t always mean there’s an oversupply.

Breast engorgement vs. inflammatory breast cancer

Breast engorgement usually affects both breasts symmetrically. Inflammatory breast cancer usually affects only one breast, so you’ll notice asymmetric swelling on just one side of your chest. This fast-growing cancer also has other symptoms like changes to your skin color or texture that appear like the skin of an orange (dimpling, redness). Other forms of breast cancer can cause one breast to be swollen, as well, due to the blocking of ducts. 

If you have just one engorged breast, contact a healthcare provider immediately. While it may not be cancer, you should get checked right away to rule out the possibility. Inflammatory breast cancer spreads quickly and needs immediate treatment.

What causes breast engorgement?

An increase in the amount of blood and lymph (a colorless, watery fluid) in your breasts causes breast engorgement. Hyperemia is the term healthcare providers use to describe an increased flow of blood to a certain area of your body. In this case, more blood than usual is flowing in your breasts to help support lactation. Lymph delivers vital nutrients to your cells and tissues while removing waste products. These extra fluids can cause your breasts to swell, leading to discomfort.

How is breast engorgement diagnosed?

Breast engorgement is a temporary condition that healthcare providers (like obstetricians and midwives) can identify during a physical exam. Your provider will examine your breasts and talk to you about how you’re feeling. They’ll also ask how breastfeeding is going and if you’re having any difficulties.

All this information can help your provider determine if engorgement is the cause of your symptoms, or if there’s another cause like ductal narrowing (clogged milk ducts) or mastitis.

What are available breast engorgement treatments?

Your healthcare provider will talk to you about the best ways to manage engorged breasts. Some options include:

• Don’t over-pump. Continue to pump or feed based on your infant’s needs.
• Take ibuprofen and acetaminophen. Follow your provider’s guidance on medication usage.
• Apply cold packs to your breast after breastfeeding. Doing so can help reduce inflammation.
• Undergo manual lymphatic drainage. Your provider can perform manual lymphatic drainage, also called lymphatic drainage massage, to improve lymph flow in your breasts. When lymph flows better in your breasts, swelling may go down. This gentle form of massage uses small circles in the armpits and above the clavicles and then gentle, sweeping motions from the nipple into the armpit and clavicle area (where lymph nodes are present to drain this fluid). Your provider may also show you how to use this technique at home.
• Try reverse pressure softening. This involves applying gentle, steady pressure in the area around your areola. This moves fluid away from the nipple to allow your baby to latch more easily. Your provider will show you how to do this technique, and you can then continue to do it on your own. Ideally, you’d use this technique for one to three minutes before each breastfeeding session for as long as your provider advises. 
• Try breastfeeding in the side-lying position. This position can help your baby latch on more comfortably when your breasts are engorged.
• Don’t massage your breasts unless your provider tells you to. They’ll advise using one of the techniques listed above, which uses gentle pressure. Using too much force or vigorously massaging your breasts can make your symptoms worse. 
• Wear a supportive bra. Doing so won’t cause mastitis (this is a myth). Proper support is essential during this time. The steady pressure of a well-fitting bra can help keep fluid moving in your breasts. Your provider can advise you on specific bra types that may help.

Can I pump to relieve engorgement?

No, pumping to relieve engorgement only worsens your symptoms. It’s a myth that you need to continuously feed your baby or empty your breasts to treat engorgement. When you empty all the milk, your body responds by making more. This makes swelling continue rather than go away.

Your provider may advise you to use a manual pump (not electric) to remove just a tiny amount of milk. Or, you may use hand expression. Removing a small amount may make you more comfortable. But be sure to follow your provider’s guidance. Don’t pump to remove a lot of milk or empty your breasts.

Can breast engorgement be prevented?

Removing milk at a frequency that matches your baby’s needs is the best way to prevent engorgement.

How long does breast engorgement last?

Early postpartum engorgement usually eases by two weeks after your child’s birth. Your provider can tell you more about what to expect in your situation.

When should I see my healthcare provider?

Talk to your obstetrician or midwife if you experience any symptoms of breast engorgement or notice other changes to your breasts. They’ll identify what’s happening and help you feel better.

You may also wish to work with a breastfeeding medicine specialist (a medical doctor with advanced training in breastfeeding management) or lactation consultant. These healthcare professionals can help you get started with breastfeeding. They’ll also support you throughout your months and years of nursing.

Call a healthcare provider right away if you:

• Have persistent or worsening symptoms.
• Have symptoms that don’t respond to treatment.
• Notice any changes in just one breast.