Breast engorgement is the condition in which the breasts become overfilled with milk, leading to firmness, tenderness, and pain, and it typically occurs 3 to 5 days postpartum or whenever the milk supply exceeds removal. Effective management and prevention are crucial to reduce the risk of breastfeeding complications such as mastitis and latching difficulties.

Breast engorgement is characterized by firm, tender, and swollen breasts that may appear larger, uneven, and shiny, with visible veins and potential swelling that extends to the armpit. Symptoms can include pain, flat or inverted nipples, and a mildly elevated body temperature, and it is common to experience some degree of engorgement in the first week postpartum.

Breast engorgement is diagnosed clinically based on signs and symptoms, without the need for tests or imaging. If symptoms worsen or fever occurs, medical attention should be sought because it may lead to more serious conditions.

Most treatments for breast engorgement focus on effective milk removal through frequent breastfeeding or pumping, and medical management is typically unnecessary for primary engorgement. Over-the-counter pain relievers like ibuprofen and acetaminophen can help alleviate symptoms, but antibiotics are not suitable for engorgement itself.

There is no evidence to support the use of oral supplements specifically for breast engorgement, although sunflower lecithin and certain probiotics are sometimes used to prevent complications like clogged ducts and mastitis, respectively. However, high-quality studies that validate these practices are lacking.

Diet and fluid intake are unlikely to influence breast engorgement, and there are no studies connecting diet to this condition. The primary factor that affects milk production is the amount of milk removed from the breasts, rather than dietary choices.

The primary treatment for breast engorgement is frequent removal of breast milk, either through breastfeeding or pumping, with techniques like manual expression and reverse pressure softening to aid latching. Comfort measures such as cold compresses, limited heat application, gentle breast massage, and wearing a supportive bra can also help alleviate discomfort.

Breast engorgement is primarily caused by hormonal changes during lactogenesis II, leading to increased milk production and swelling, which typically resolves within the first week postpartum. Secondary engorgement can occur later on due to a mismatch between milk production and removal, which is influenced by various factors related to both the lactating parent and the infant.