Breast engorgement
Encyclopedia
Breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...

 engorgement
occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk
Breast milk
Breast milk, more specifically human milk, is the milk produced by the breasts of a human female for her infant offspring...

.

It can be a cause of mastodynia.
Engorgement usually happens when the breasts switch from colostrum
Colostrum
Colostrum is a form of milk produced by the mammary glands of mammals in late pregnancy. Most species will generate colostrum just prior to giving birth...

 to mature milk (often referred to as when the milk "comes in"). However, engorgement can also happen later if lactating women miss several nursings and not enough milk is expressed from the breasts. It can be exacerbated by insufficient breastfeeding
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...

 and/or blocked milk ducts. When engorged the breasts may swell, throb, and cause mild to extreme pain.

Engorgement may lead to mastitis
Mastitis
Mastitis is the inflammation of breast tissue. S. aureus is the most common etiological organism responsible, but S. epidermidis and streptococci are occasionally isolated as well.-Terminology:...

 (inflammation of the breast) and untreated engorgement puts pressure on the milk ducts, often causing a plugged duct. The woman will often feel a lump in one part of the breast, and the skin in that area may be red and/or warm. If it continues unchecked, the plugged duct can become a breast infection, at which point she may have fever or flu-like symptoms.

Causes

Breast engorgement is caused by an imbalance between milk supply and infant demand. This condition is a common reason that mothers stop breast-feeding sooner than they had planned.

Breast engorgement can occur due to four main factors such as a suddenly increased milk production that is common during the first days after the baby is delivered or when the baby suddenly stops breastfeeding either because it is starting to eat solid foods or it is ill and has a poor appetite. Breast engorgement may also be caused when the mother does not nurse or pump the breast
Breast pump
A breast pump is a mechanical device that extracts milk from the breasts of a lactating woman. Breast pumps may be manual devices powered by hand or foot movements or electrical devices powered by mains electricity or batteries.- History :...

 as much as usual.

After the first 3 to 4 postpartum days, the quantity of colostrum is quickly replaced by an increased milk production. When milk production increases rapidly, the volume of milk in the breast can exceed the capacity of the alveoli to store it and if the milk is not removed, the alveoli become over-distended which can lead to the rupture of the milk-secreting cells

Accumulation of milk and the resulting engorgement are a major trigger of apoptosis, or programmed cell death, that causes involution of the milk-secreting gland, milk resorption, collapse of the alveolar structures, and the cessation of milk production.

Severe breast engorgement can lead to the flattening of the nipples or, it can result in inverted nipples which make it impossible for the baby to suck out all the milk from the breast. This is one of the common causes of the stagnation of milk in the breast.

Not all women experience breast engorgement after they give birth and some degree of engorgement of the breast is however normal within the few postpartum days. Women with mild to moderate hypoplastic breasts
Hypoplasia
Hypoplasia is underdevelopment or incomplete development of a tissue or organ. Although the term is not always used precisely, it properly refers to an inadequate or below-normal number of cells. Hypoplasia is similar to aplasia, but less severe. It is technically not the opposite of hyperplasia...

 with a wide intramammary space (>1 inch) and a tubular shape are at particular risk for producing less than 50 percent of the milk necessary for the first week. More concerning are the moderate to severe degrees of breast engorgement. In these cases, the condition can continue for up to ten days or more even though the patients will experience serious symptoms only during the first six days.

Overfilled breasts can lead to severe engorgement due to waiting too long to begin breastfeeding the baby, not feeding often enough or due to small feedings that do not empty the breast, very common in cases when the baby is fed formula or water. Severe engorgement of the breast can lead to breast infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

.

Treatment

As women are naturally prone to suffer from some degree of breast engorgement, the main part of treatment is prevention. This means breastfeeding the baby whenever he or she seems hungry and making sure that the baby is latching on and feeding well. In cases when the baby is not hungry enough to empty the breasts, the breast should be nursed or pumped.

Avoiding caffeine and chocolate as well as wearing a well fitting maternity bra with wide straps that do not scratch and with a cup that comfortably holds the entire breast usually help in easing the discomfort and other symptoms.

If the symptoms persist and tend to worsen, the patient is advised to seek a doctor. Depending on the severity of the condition, the doctor may recommend pain killers such as ibuprofen
Ibuprofen
Ibuprofen is a nonsteroidal anti-inflammatory drug used for relief of symptoms of arthritis, fever, as an analgesic , especially where there is an inflammatory component, and dysmenorrhea....

, cool water compresses, massaging and nursing the breasts.

If the cause is not due to pregnancy then the best remedy is self therapy (milking of the breast).

Symptoms

Patients who suffer from breast engorgement may experience a gradually raising body temperature, pain and tenderness in one of both breasts and a general malaise. A first sign of moderate of mild engorgement of the breasts is considered to be a slightly raised temperature, of even 1 to 2 degrees on the 3rd or 4th days after giving birth. The engorged breast feels tense and heavy and acutely painful on movement.

The first signs of the condition are the swollen, firm and painful breasts. In more severe cases, the affected breast becomes very swollen, hard, shiny, warm, and slightly lumpy when touched. Breast engorgement also causes slightly swollen and tender lymph nodes in the armpits.

The condition may cause edematous and flushed nipples. In cases when the breast is greatly engorged, the nipple is likely to retract into the areola. Commonly, patients experience loss of appetite, fatigues, weakness and chills.

The symptoms of breast engorgement are however similar to the symptoms caused by the Inflammatory Breast Cancer. This is one of the most aggressive types of breast cancer and patients who experience any of the symptoms mentioned above are recommended to seek medical care.

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