Breast engorgement

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Breast engorgement
Breast engorgement in a women who is breastfeeding
SpecialtyFamily medicine
SymptomsPainful and hard breasts[1]
ComplicationsMastitis, cracked nipples, stopping breastfeeding[2]
Usual onsetShortly following delivery[2]
DurationUp to 2 weeks[2]
Risk factorsNot enough breastfeeding, ineffective feeding, excessive milk production, breast implants[2]
Differential diagnosisMastitis, blocked milk duct, breast abscess, yeast infection[1]
TreatmentRemoving milk, specifically designed bra, ibuprofen or acetaminophen (paracetamol), applying cold[1][2]
Frequency15% to 50% of women[2]

Breast engorgement occurs when the breasts are overly full with milk.[1] Symptoms may include pain and the breasts may feel hard.[1] The nipple may also become flat which may make it hard for the baby to feed.[1] Onset is often in the days after delivery with both breasts being involved.[2][3] Complications may include mastitis, cracked nipples, or a women stopping breastfeeding.[2]

It generally occurs due to insufficient removal of breast milk.[2] This may occur due to not enough breastfeeding, ineffective feeding, or excessive milk production.[2] Other risk factors may include breast implants.[2]

It may be improved by either breastfeeding or removing some milk by hand.[1] Removing milk by hand; however, may increase milk production.[4] Other measures may include a specifically designed bra for breastfeeding, taking ibuprofen or acetaminophen (paracetamol), or apply cold gel packs or cabbage leaves.[1][2] Generally symptoms improve within 2 weeks of delivery.[2] About 15% to 50% of women are affected.[2]

Signs and symptoms

Symptoms include the breasts being swollen and the skin appearing shiny and diffusely red. Usually the whole of both breasts are affected, and they are painful. The woman may have a fever that usually subsides in 24 hours. The nipples may become stretched tight and flat which makes it difficult for the baby to attach and remove the milk. The milk does not flow well.[5]

A fever may occur in 15 percent, but is typically less than 39 degrees C and lasts for less than one day.[6]


Failure to remove breast milk, especially in the first few days after delivery when the milk comes in and fills the breast, and at the same time blood flow to the breasts increases, causing congestion. The common reasons why milk is not removed adequately are delayed initiation of breastfeeding, infrequent feeds, poor attachment, ineffective suckling,[5] a sudden change in breastfeeding routine, suddenly stopping breastfeeding, or if a baby suddenly starts breastfeeding less than usual.[7]


Breastfeed frequently is recommended. If the baby is not able to attach and suckle effectively, express milk by hand or with a pump a few times until the breasts are softer, so that the baby can attach better.[8] Warm compresses can be applied to the breast or a warm shower before expressing, can help the milk to flow. Cold compresses after feeding or expressing, may help. Engorgement occurs less often in baby-friendly hospitals which practise the Ten Steps and which help mothers to start breastfeeding soon after delivery.[5]

Regular breastfeeding can and should be continued.[9] The treatment for breast engorgement can be divided into non-medical and medical methods. The non-medical methods include hot/cold packs. Cabbage leaves are often cited as a possible treatment but studies have found they provide no overall benefit.[9] Evidence from trials on the effectiveness of treatment options is of weak quality and is not strong enough to justify a clinical recommendation.[9]

See also


  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 "Breast pain and breastfeeding". 7 December 2020. Archived from the original on 17 January 2024. Retrieved 25 January 2024.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 Zakarija-Grkovic, I; Stewart, F (18 September 2020). "Treatments for breast engorgement during lactation". The Cochrane database of systematic reviews. 9 (9): CD006946. doi:10.1002/14651858.CD006946.pub4. PMID 32944940.
  3. Jacobs, A; Abou-Dakn, M; Becker, K; Both, D; Gatermann, S; Gresens, R; Groß, M; Jochum, F; Kühnert, M; Rouw, E; Scheele, M; Strauss, A; Strempel, AK; Vetter, K; Wöckel, A (December 2013). "S3-Guidelines for the Treatment of Inflammatory Breast Disease during the Lactation Period: AWMF Guidelines, Registry No. 015/071 (short version) AWMF Leitlinien-Register Nr. 015/071 (Kurzfassung)". Geburtshilfe und Frauenheilkunde. 73 (12): 1202–1208. doi:10.1055/s-0033-1360115. PMID 24771901.
  4. "Overview of Postpartum Care - Women's Health Issues". Merck Manuals Consumer Version. Archived from the original on 11 January 2024. Retrieved 25 January 2024.
  5. 5.0 5.1 5.2 "Management of breast conditions and other breastfeeding difficulties". National Center for Biotechnology Information US National Library of Medicine. Archived from the original on 18 January 2017. Retrieved 4 August 2017.Public Domain This article incorporates text from this source, which is in the public domain.
  6. "37". Williams obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8.
  7. "What is Engorgement? What Causes It?". Archived from the original on 2017-11-24. Retrieved 2023-01-29.
  8. "Warning Signs of Breastfeeding Problems". Archived from the original on 2020-10-30. Retrieved 2020-10-29.
  9. 9.0 9.1 9.2 Zakarija-Grkovic, Irena; Stewart, Fiona (18 September 2020). "Treatments for breast engorgement during lactation". The Cochrane Database of Systematic Reviews. 2020 (9): CD006946. doi:10.1002/14651858.CD006946.pub4. ISSN 1469-493X. PMC 8094412. PMID 32944940.

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