Introduction

Breast engorgement is a common experience for breastfeeding mums, especially in the early days post-birth. If your breasts feel tight, painful, or as hard as rocks, it’s likely you’re experiencing engorgement—a condition that, though uncomfortable, can be managed with the right support and techniques. This guide will help you understand what breast engorgement is, why it happens, and how you can find relief.

Whether you’re a new mum or a supportive loved one, this comprehensive guide covers everything you need to know to manage and prevent breast engorgement, making your breastfeeding journey more comfortable and enjoyable.

What is Breast Engorgement?

Breast engorgement occurs when the breasts become overly full of milk, blood, or other fluids, causing them to feel hard, tight, and sometimes painful. This typically happens when your body is adjusting to the demand for milk. As your breasts fill up with milk, they may swell and become tender, creating discomfort for many new mums (NHS, 2021).

Within your breasts there are glands that produce breastmilk which is carried to your nipple via ducts [2]. Breastmilk is always being produced by these cells, if you are lactating. If it is not being taken by your baby or expressed/pumped then your breasts become more and more full. This can cause inflammation where more fluid and blood will be sent to your breasts.

Engorgement happens when your breasts are essentially swollen - full of breastmilk and sometimes excess fluid and blood. This can make your breasts feel hard and your skin stretched and tight. This can be incredibly uncomfortable and painful with even gentle pressure.

But don’t worry, you won’t actually burst! Your body will stop producing milk once it adjusts, but there can be serious complications if engorgement is not treated and it will take time for your body to stop producing breastmilk.

How Long Does Engorgement Last?

In most cases, engorgement is temporary, especially in the early days of breastfeeding when your body is working to balance milk production with your baby’s needs. Engorgement usually subsides within a few days as your body adapts, but there are ways to relieve it in the meantime to ensure you stay as comfortable as possible.

Causes of Breast Engorgement

Engorgement is caused when breastmilk builds up in your breasts. This often happens when:

Your ‘milk comes in’ - in the first days after birth you produce a type of milk called colostrum, which is thicker and in small volumes [6].
This transitions to mature milk and in much larger volumes. In the early weeks, your body is working out how much milk your baby/ies need and then your milk supply will start to settle down.
If you have an oversupply - this is where your body is producing more milk than your baby is taking or you are expressing/pumping.
Your baby is breastfeeding less - again, if your body is producing more milk than is being taken then it can build up.
This might happen if your baby is not latching or feeding effectively, you are not breastfeeding as often, you are away from baby more than usual or you have stopped breastfeeding.

Symptoms of Breast Engorgement

Symptoms of breast engorgement are usually easy to identify. You may experience:

Hard, swollen, or tight breasts
Discomfort with light pressure
Difficulty with your baby latching due to firmness around the nipple

These symptoms often indicate that implementing some simple self-care will help you reduce the risk of further discomfort and possible complications.

How to Relieve Breast Engorgement

If you’re experiencing engorgement, there are several ways to relieve the discomfort.

If possible, try to keep your breasts as soft as possible to try and prevent engorgement - see the information below. If you do feel your breasts are engorged then it is important to relieve it as soon as possible, not only to ease your discomfort but also to avoid complications such as blocked ducts and mastitis.

There are several things you can do:

Soften your breasts

The first course of action should be to take some of the milk out, which will in turn help to reduce the swelling. You can do this by:

Responsively breastfeeding your baby
If you are breastfeeding, look for your baby’s feeding cues and offer a feed as soon as they are hungry.
This will help to relieve any build up of milk regularly. If you are not sure whether your baby is hungry, you can offer a feed anyway. You can also offer a feed to relieve engorgement and any discomfort for yourself.
Hand expressing
Hand expressing is a fantastic skill and useful if your breasts are still feeling engorged after feeding your baby or if you do not want to or are unable to feed your baby.
Hand expressing is gentle and you can aim to remove just enough milk to help you feel more comfortable and soften your breasts.
Try not to express any more than is necessary as your body will produce more milk with the more you remove, increasing your supply and the risk of engorgement.
See this video on how to hand express - How to Express Breastmilk - Video - Global Health Media Project.
Pumping
If hand expressing is not possible then you could use a breast pump/haakaar. Again, it is best to let your baby feed effectively to soften your breasts, but if this is not possible remember not to pump any more than is necessary as your body will produce more milk with the more you remove, increasing your supply and the risk of engorgement.

Tip! - Before feeding or expressing/pumping, you can place a warm (not hot) flannel over your breasts - the heat will help with your let down. Don’t use this beyond helping your let down though as heat can increase inflammation [5].

Tip! - You might also find that your baby has difficulty latching, and expressing/pumping is more difficult when your breasts are swollen. You can use ‘reverse pressure softening’ which will temporarily make the breast tissue around your nipples softer. Avoid this though if you might have a blocked duct or mastitis.

Support your breasts

As well as softening your breasts, you can support them by wearing a well-fitting bra. This will help you to feel as comfortable as possible, as the weight of your breasts can be painful.
It is also important though that your bra is not restrictive and does not dig in as this will increase the risk of developing blocked ducts and mastitis.

Pain relief

Between breastfeeding or expressing/pumping, you can apply cold flannels or ice packs wrapped in a cloth to your breasts. This can also help to reduce any swelling or inflammation.

Tip! Do cabbage leaves really work?

You might hear that some people advise putting chilled cabbage leaves in your bra to help with breast pain like engorgement, mastitis etc. But does it work?
There are very few studies into this so limited evidence but… many women report that it helps. The problem is that there is some evidence to say that it may reduce your supply [5] and this can have have a negative effect on your breastfeeding journey and goals, with breastfeeding stopping sooner than you would like.

So if you have tried all other suggestions on this page and want to consider using cabbage, make sure you are clued up as to the risks on your supply and use sparingly -kellymom advises for no more than 20 minutes up to 3 times per day.

Over the counter painkillers like paracetamol and ibuprofen may be suitable, if advised by your midwife/health visitor [1].
You can also find information about the safety of painkillers whilst breastfeeding here: Analgesics (Pain killers) and Breastfeeding - The Breastfeeding Network

Lymphatic drainage

Your breasts are surrounded by your lymph node system, which helps to carry excess fluid away. So, another recommendation is to carry out some gentle touch in certain areas around and over your breasts to encourage this system to clear away some of the fluid.

This is the technique recommended by the ABM [3]:

On Instagram @olivia_lactation_consultant has a great post demonstrating lymphatic drainage technique.

Preventing Breast Engorgement

Keeping your breasts soft and avoiding engorgement can prevent discomfort. Here are some preventive steps:

Feed Frequently: Aim to breastfeed responsively, particularly in the early weeks.
Wear a Supportive Bra: Use a well-fitted, non-restrictive bra that offers gentle support without digging into your skin.
Reduce inflammation with self-care: If your breasts feel overly full between feeds or uncomfortable, use lymphatic drainage and cool compresses to reduce the inflammation.

Taking these steps can help maintain a comfortable breastfeeding routine and minimise the chances of engorgement.

Complications of Untreated Engorgement

Complications of engorgement

If engorgement continues there are some risks, including:

Blocked ducts and Mastitis

Having a blocked duct can quickly develop into mastitis which can make you feel very unwell, and can develop into a serious infection and abscess. Therefore if you notice any of these symptoms you should seek advice and treatment straight away[1]:

small, tender lump in your breast
your breast feels hot and tender
a red/darkened patch of skin on your breast that's painful to touch
a general feeling of illness, as if you have flu, achy, tired and tearful
a high temperature

Seek breastfeeding support straight away and advice from your GP or call 111.

Changes to Mastitis Advice

The Academy of Breastfeeding Medicine updated the advice on treating mastitis in 2022 (protocol 36) PROTOCOLS (bfmed.org).
It now advises against deep massage of your breast, as this can increase inflammation. Instead, lymphatic drainage and light sweeping of the skin are more effective [3].

Reduction in your milk supply

Your body is very clever, including when it comes to producing breastmilk. Your milk contains a protein called Feedback Inhibitor of Lactation (FIL) and this means that the more milk that is in your breast, the slower your body will produce more [4]. So, an emptier breast fills more quickly than a fuller one!

If you are engorged, your breast is fuller and contains more FIL. Therefore, your body will slow down the production of more milk and if this happens frequently, your body will adjust and think that you need less milk.

FIL is also the reason though to be mindful not to remove much more milk than your baby needs - as there will be less FIL in your breasts and your body will speed up production of more milk. Again, if this happens frequently then your body will think you need more milk and this can create an oversupply.

Not sure what to do next?

If you are uncomfortable or in pain then consider seeking medical advice from your midwife, health visitor or GP. If you are concerned about any aspect of breastfeeding your baby then you can contact me or seek further feeding support.

If things aren’t improving

If you have followed the above advice but do not see any improvement, or feel things are getting worse then seek medical advice from your midwife, health visitor or GP. It might also be beneficial to seek breastfeeding support so you can reduce the risk of any impact on your supply and your breastfeeding goals. You can contact me or seek further feeding support.

Conclusion

Breast engorgement can be an uncomfortable experience, but with the right care and support, you can manage it effectively. By understanding what causes engorgement, knowing how to relieve it, and taking preventive steps, you’ll find your breastfeeding journey more comfortable. If you ever feel unsure or symptoms worsen, don’t hesitate to reach out to a healthcare provider or breastfeeding specialist for guidance.

Engorgement is a temporary part of the breastfeeding experience for many, and with these tips, you’ll have the knowledge and tools to feel more comfortable and supported.

Sources

[1] Breast pain and breastfeeding - NHS (www.nhs.uk)
[2] The biology of breast cancer | Breast Cancer UK
[3] ABM Protocol #36.pdf (bfmed.org)
[4] How does milk production work? - KellyMom.com
[5] Engorgement - KellyMom.com
[6] The physiological basis of breastfeeding - Infant and Young Child Feeding - NCBI Bookshelf (nih.gov)