Breast Engorgement Causes, Treatments, and Prevention

Breast engorgement is the development of hard, swollen, and painful breasts when too much breast milk accumulates in the milk ducts. Engorged breasts can feel tight, lumpy, and tender and the swelling may go all the way up into your armpit. Also, the veins on the surface of your breasts may become more visible or even stick out.

This condition frequently occurs when breast milk first comes in, though it can happen at other times as well. While the condition is uncomfortable, it can be relieved by releasing the excess milk from the breast and taking steps to ease discomfort. Here is what you need to know about breast engorgement including tips on addressing the issue.

Breast Engorgement After Birth

Some degree of breast engorgement is normal during the first week or two after your baby's birth. An increase in blood flow to your breasts along with a surge in your milk supply often results in your breasts getting overly full.

If you're breastfeeding, this stage of breast engorgement typically starts to get better within a few days as your feeding habits take hold and your milk production adjusts to meet your baby's needs. Those who aren't planning to breastfeed also experience breast engorgement.

Because your body doesn't know your feeding plans, it will make breast milk. You'll begin to feel the telltale fullness when your milk comes in between the third and fifth day postpartum.

If you don't remove the breast milk, your body will gradually stop making more. The uncomfortable part of engorgement should only last a few days, but you'll continue to make milk for a few weeks until production fully tapers off.

Other Causes of Engorgement

Whenever breast milk builds up in your breasts and it's not removed regularly or fully, swelling and firmness can develop. The following situations can lead to breast engorgement.

Schedule Changes

Whether you nurse, pump, supplement with formula, or do any combination of the three, schedule changes can have a big impact on your milk supply. When milk that is normally expressed at a certain time isn't, it sits in the breasts and causes them to fill, which can quickly lead to breast engorgement if not managed.

For instance, you might notice engorgement when your baby's nap schedule changes and they are now sleeping during what would normally be a feeding time. Going back to work also can lead to engorgement.

Even when you can nurse or pump, there may be a change that leads to engorgement. For example, your child may have trouble nursing if they are sick and have a stuffy nose, which can lead to not eat as much.

If engorgement does happen, the key is to go easy on yourself. Nursing parents are tired and busy, so it's easy for breast engorgement to sneak up on you.

Overabundant Milk Supply

Generally, the amount of breast milk your body makes is based on demand. The more your baby nurses, the more milk is produced, optimally at just the right level to keep your baby full but not engorge your breasts.

However, this process can occasionally get out of whack, particularly when your supply is just getting established. And producing too much milk, or hyperlactation, can cause engorgement.

Weaning or Supplementing

Breast engorgement also can happen when you make adjustments to your baby's diet, such as adding first foods, supplementing with formula, or switching to formula or milk. (Note: The American Academy of Pediatrics does not recommend cow's milk for babies until age 1.)

If you're supplementing your child with formula between feedings, they may not drink as much while nursing, which can result in a temporary oversupply. Also, if weaning takes place too rapidly, the same situation occurs. For this reason, gradually reducing the length and frequency of feedings is recommended.

How to Relieve Breast Engorgement

Whatever the cause, the fullness and pressure of breast engorgement can be painful and make nursing harder. Luckily, this condition is typically short-lived. Usually, you can find relief in a day or two. Here's what you can do to cope with engorgement and prevent it from happening again.

Breastfeed Often

Breastfeed your baby (or pump) regularly. Offer your child the breast, ideally every 1 to 3 hours throughout the day and night. While you should let them breastfeed for as long as they want, aim for at least 20 minutes at each feeding. If you have a sleepy baby, wake them up for feedings.

Unless otherwise directed by your pediatrician, avoid giving your baby formula in between breastfeeding sessions. This way, they will take breast milk when it's time to nurse.

If you are supplementing, pump or hand express milk when your baby is fed formula to relieve and prevent engorgement. Be careful not to express too much, though.

Make Breastfeeding Easier

Take a warm bath or shower, or apply warm compresses to your breasts, just before nursing or pumping—but not in between feedings, as this can worsen swelling. The warmth can help with your let-down reflex and get your milk flowing.

Use a hand expression technique or a breast pump to remove a little bit of breast milk before each feeding. This will help soften your breasts, reduce the speed of the milk's flow, and make it easier for your baby to latch on. Your also can massage your breast as your baby nurses to help relieve tightness and remove more milk.

Use Different Breastfeeding Positions

Alternate breastfeeding positions to drain all the areas of your breasts. A healthcare provider or a lactation consultant can advise you on the best positions or techniques. If you are pumping, be sure to pump each breast so that both sides are fully drained and one breast doesn't inadvertently get overstimulated.

You can, however, do one breast and then take a break and do the next breast an hour or a few hours later, if desired. Just be sure that both sides are adequately drained.

Soothe Pain

Placing a cold compress or cabbage leaves on your breasts after each feeding can provide significant relief from pain and swelling. Slip them under your bra to help them stay in place. But only use them when needed. Excessive use can result in reduced milk supply.

Talk to a healthcare provider about taking an over-the-counter pain medication such as Tylenol (acetaminophen) or Motrin (ibuprofen) to help ease the pain and inflammation. Wearing a snug, supportive bra and getting plenty of rest also can help.

Complications of Engorged Breasts

While breast engorgement usually goes away on its own with proper management, it can create problems for both the breastfeeding parent and baby. Here is what you need to know about the risks of prolonged engorgement.

Problems for the Baby

Engorgement can sometimes lead to an overactive let-down reflex. This fast flow can cause your baby to briefly gag, choke, and swallow excessive amounts of air as they're trying to latch on and feed. If this is a recurrent problem, pump a bit of milk before each nursing session.

Low milk supply may not seem like a likely outcome of engorgement, but it is possible if the issue is persistent. Engorgement makes your breasts full and hard, which can cause your nipples to become flat. This can cause a poor latch and result in your baby drinking less. When this milk stays inside the breast, it signals that milk is not needed and slows milk production.

Some babies may also go on a nursing strike during engorgement due to frustration from trying to latch on or coping with a strong letdown. Low milk supply aside, this alone can cause poor weight gain and erode breastfeeding confidence.

Problems for the Breastfeeding Parent

Many people leave the hospital within a few days of childbirth, so breast engorgement often begins at home. Because this condition can be painful and cause difficulty with latching on, it's a common cause of early weaning.

Many nursing parents expect breastfeeding to be easy but find that getting the hang of it can actually be challenging. Know that it's not your fault and these are common issues.

In addition to the discomfort, engorgement also can lead to a host of issues. These include painful blebs (blisters covering a nipple opening), plugged milk ducts, sore nipples, or mastitis. Always consult a healthcare provider or lactation consultant to ensure you have the correct diagnosis.

A Word From Verywell

Knowing what breast engorgement is, when it's likely to occur, and how to treat it can help you deal with this common nursing problem quickly—and get your breastfeeding experience back on track. Remember, this condition is temporary and can be addressed with simple tactics.

Try things like nursing consistently, draining breasts fully, weaning slowly, nursing equally on each side, and using ice packs or cabbage leaves to help reduce any swelling. If you develop a fever or a red, warm spot on your breast, talk to a healthcare provider or lactation consultant. They can determine if your engorgement has progressed to an infection.