Tips from an LC: What is Normal Breast Fullness and What is Breast Engorgement?

Video Transcript

It’s normal for your breasts to feel full on average around the 2nd to 3rd days after birth. When we describe the milk as “coming in”, what is actually meant is that the volume of milk increases. Once your milk comes in, you will definitely know it! For most moms, there is no missing the increase in size of their breasts!

As your milk comes in, obviously there is a lot of activity happening so you may feel a little warmer around the breast area, and this can even feel uncomfortable for 24 hours or so. As your baby starts to drink more, your breasts will regulate themselves and the sense of over-fullness will settle.

With normal fullness, the breast and areola (which is the darker skin around your nipple) remain soft, your milk flow is normal, and your baby can still latch on easily. 

Engorgement is slightly different:

• Engorgement typically begins on the 3rd to 5th day after birth, and subsides within about 12 - 48 hours, if properly treated.
• It might occur in one or both breasts.
• Your breast and areola will likely feel hard, with tightly stretched skin that may appear shiny, and you may experience warmth and tenderness. Engorgement may extend up into your armpit as well, as the breast tissue inside is shaped like a teardrop.
• Your nipple may also increase in size and become flatter or pulled in towards your breast slightly, making latching on more challenging for your baby.
• You may also have a low-grade fever.

So, What are the Best Tips to Prevent Breast Engorgement?

Breastfeed early and often:

• Don’t skip or delay feeds (even at night).
• Breastfeed every time your baby cues for a feed.
• If your baby is very sleepy, then wake them every 2-3 hours and allow one longer stretch of 4-5 hours at night.
• Allow your baby to finish feeding at the first breast before offering the other side.
• Seek help to ensure you are latching your baby onto the breast correctly and comfortably.
• If your baby is not able to breastfeed well or frequently enough, you will need to pump your breasts to make up for the missing feeds. A baby should be feeding a minimum of 8 times in 24 hours (i.e. if your baby is sleepy and only breastfeeding 4 or 5 times a day, it is important to pump the extra 4 times to keep your milk supply flowing and to minimize the engorgement).

How Can I Cure Breast Engorgement?

Before breastfeeding:

• Gently massage your breast from the chest wall toward the nipple.
• You may find cool compresses are both soothing and helpful. Use these for up to 20 minutes before feeding.
• A warm, wet cloth held on your breasts or a warm shower (with shower hitting your back, rather than directly onto your breasts) for a few minutes before breastfeeding may help your milk begin to flow (but do not use this if you have any oedema/swelling in your breast as it could make it worse!)
• If your baby is having difficulty latching on to feed, try expressing some milk out first to soften the nipple and areola.
• Something called reverse pressure softening can also be a helpful tip to look up.
• Continue to gently massage your breast during breastfeeding as well, to help the milk flow.

Between feeds:

• If your breast is uncomfortably full at the end of a feed, then express your milk until your breast feels a little more comfortable. But only express to comfort!
• Some moms find that using a cold compress (over a layer of clothing) for 20 minutes can be very soothing.
• Make sure your bra is also comfortable and well-fitting. Tight or poor-fitting bras can dig in on your breast and potentially lead to blocked ducts and mastitis.

Contact your lactation specialist or healthcare provider if the engorgement is not relieved within 24 - 48 hours, or you feel that it is getting worse. And if your baby is unable to breastfeed, not waking regularly for feeds (i.e. feeding less than 8 times in 24 hours), or they’re showing signs that they are not getting enough milk, please seek further support and advice from a healthcare professional.