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Hard, Swollen, Painful Breasts

Causes, Treatments and Complications of Breast Engorgement

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Updated June 20, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

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What is Engorgement?

The development of hard, swollen, painful breasts that result from an overabundance of breast milk is called engorgement. The breasts can become extremely large, tense, lumpy, and tender. The veins on the surface of the breasts may also protrude and become very visible.

When Does Engorgement Occur?

Within the first few days to a week after the birth of your baby, some degree of engorgement is normal. An increase in blood flow to your breasts along with a surge in your milk supply can cause heavy, overfull breasts. This will usually resolve in a few days as your body adjusts to your baby's needs.

Painful, swollen breasts can also arise at other times and for other reasons. If you skip a feeding or miss a pumping session, you may begin to feel the heavy, fullness of engorgement. When it does occur it should be addressed as soon as possible to prevent complications. If left untreated hard, swollen breasts can lead to potentially serious issues including painful blebs, plugged milk ducts or a breast infection called mastitis. Difficulty breastfeeding and problems with your milk supply could also result.

What Causes Engorgement?

Whenever breast milk builds up in your breasts and is not effectively removed, swelling and firmness can develop. It is most often the result of one of the following situations:

Things You Can Do

Feed your baby frequently. Offer her the breast very often, at every 1 to 3 hours, and let her nurse for as long as she wants at each feeding.

If you have a sleepy baby, wake the baby up for feedings.

Use hand expression or a breast pump to remove a little milk before each feeding to help relieve some of the tightness, soften the breast and make it easier for your baby to latch on.

Massage the breast or use breast compression as your baby nurses to help remove more milk.

Apply a cold compress or cabbage leaves after feedings to relieve pain and decrease the inflammation.

Alternate breastfeeding positions to drain all the areas of your breasts.

Talk to your doctor about taking an over the counter pain medication to help relieve pain and reduce swelling.

Nurse from only one side for an entire feeding to help drain that breast. Start the next feeding on the opposite side.

Do not supplement with formula or give your baby water. Your baby will take less breast milk and you will become engorged.

Take a warm shower or apply a warm compress just before nursing to help with the let-down reflex and get your milk flowing. However, do not apply heat between feedings since it can make the swelling worse.

Get plenty of rest.

Watch for signs of blebs, plugged ducts or infection.

Contact your doctor, a lactaction consult or a local La Leche League group to evaluate your breastfeeding technique.

Complications of Engorgement

Poor latch: If your breasts are full and hard, your nipples may become flat making it very difficult for your baby to latch on.

A low milk supply: If the swelling is not relieved and your baby is unable to latch on, your milk will not be removed. When the milk is not removed it can not stimulate the production of more milk and this can put your milk supply at risk. A decreased milk supply can also result from the overuse of cold compresses and cabbage leaves.

Poor weight gain for your baby: If your baby is having trouble latching on to your breast, he may not be able to get enough milk.

A strong flow: The pressure from the backup of milk in your breasts can lead to an overactive let-down reflex and very fast flow. This can cause your baby to gag, choke and swallow air from gulping down the milk so fast.

Breast refusal: Your baby may become frustrated from a difficult latch, not getting enough milk or a very fast flow. This can result in a nursing strike.

Breast problems: Engorgement can lead to sore nipples, blebs, plugged ducts and mastitis.

Tips To Prevent Engorgement During Weaning

  • If possible, do not wean your baby very quickly. Gradual weaning will help to decrease the milk supply over a period a time therefore preventing full, painful, swollen breasts.

  • Wear a tight, supportive bra.

  • Ask your doctor if you can take acetominophen or ibuprophen to relieve pain.

  • Use ice packs or cabbage leaves to help reduce swelling.

  • Express a small amount of milk to relieve some pressure and discomfort. Be careful not to express too much or your body will continue to produce more milk.

Sources:

American Academy of Pediatrics. New Mother’s Guide To Breastfeeding. Bantam Books. New York. 2011.

Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Sixth Edition.  Mosby. Philadelphia. 2005.

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