Breastfeeding (breast engorgement)

In breast engorgement there is both milk and tissue fluid overfilling the breast (1).

It is caused by

• venous and lymphatic stasis - before the onset of milk secretion (2)
• obstruction of the lactiferous ducts - approximately 48 - 96 hours after birth, the mother's breast fills with milk and inadequate emptying of milk leads to over distension of the alveolar space (2,3).

Engorgement of the breast is usually seen within a week after birth (can be later too). It can be divided into

• primary engorgement - seen during the first few days after the infant is born where the mother's body is trying to adjust to the demand for breast milk from the baby
• secondary engorgement - occurs later where there is less frequent/restricted feeding or decreased demand from the baby

Typical clinical features include:

• the breast is hard tender and/or painful (2)
• the skin becomes shiny and diffusely red
• usually both breasts are affected
• nipples may be stretched tight and flat
• there is difficulty for the baby to attach and remove milk
• milk does not flow easily
• a fever which subsides within 24 hours is usually present (1)

Augmentation mamoplasty has been identified as a cause since breast engorgement is seen more commonly in mothers who have had such operations (3).

Reference:

• 1. World Health Organisation (WHO) 2000. Mastitis. Causes and management
• 2. National Collaborating Centre for Primary Care (NCCPC) 2006. Postnatal care. Routine postnatal care of women and their babies
• 3. Mangesi L, Dowswell T. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev. 2010;(9):CD006946