Breast engorgement

What is breast engorgement?

Breast engorgement is severe swelling and tenderness in the breast. It is caused by having too much milk, blood, and lymph fluid in the breast. The breasts become very hard and painful. Engorgement is most common in the first week after birth but can happen whenever breastfeeding or expressing is suddenly reduced or interrupted. It can be avoided by effective breastfeeding or expressing. Engorgement can also make the nipple root hard, causing latching problems and nipple pain and damage. It can cause a decrease in the eventual milk supply and should be treated as soon as possible.

A) Describing breast filling and engorgement

Engorgement of both breasts. The breasts are very hard and painful.

Breasts that are making colostrum or milk and are not emptied regularly by effective breastfeeding or expressing can end up holding too much colostrum or milk, blood, and lymph, a watery, clear fluid that is similar to blood but does not contain red blood cells. Breast filling can range from mildly full to severely overfull (engorged).

B) Causes of engorgement

Engorgement is most common on Days 3 to 5 after birth but can happen whenever breastfeeding or expressing is suddenly interrupted.

Breast engorgement can develop in the first week after birth if mothers:

It can also happen if:

Engorgement more commonly affects both breasts. It may affect only one breast if:

  • A newborn baby can latch onto one breast but not the other.
  • A mother suddenly stops breastfeeding or expressing from one breast.
  • A baby is only breastfeeding on one breast, has weaned from the other, and suddenly stops breastfeeding.
  • Milk is suddenly stopped from leaving the breast because of an infection (mastitis or an abscess) or a lump.

Breast engorgement affects the whole breast. If only a part of the breast is full or hard, look for another cause.

C) Problems caused by engorgement

With engorgement, the breast may be:

  • Very firm and even hard
  • Slightly red in colour
  • Painful

Mothers may feel unwell and have a low fever (Almeida 1986).

Engorgement can cause fluid to build up in the nipple root, making it hard. Use the pinch test to assess this. This increases the risk of:

Breast engorgement can prevent the mother from ever having enough milk or reduce the amount of milk made.

Occasionally engorgement is misdiagnosed as mastitis resulting in inappropriate antibiotic use. However engorgement can lead to mastitis in one breast.

It must be treated effectively and as soon as possible.

References

Alekseev NP, Vladimir II, Nadezhda TE. Pathological postpartum breast engorgement: prediction, prevention, and resolution. Breastfeed Med. 2015 May;10(4):203-8
 
Almeida OD Jr, Kitay DZ. Lactation suppression and puerperal fever. Am J Obstet Gynecol. 1986 Apr;154(4):940-1
 
Berens P, Brodriff W. Academy of Breastfeeding Medicine (ABM) Clinical Protocol #20, Engorgement, Revised 2016. Breastfeeding Med. 2016;11(5);159-63