Postpartum breast swelling is very common and can cause significant discomfort and difficulty with breastfeeding in the first weeks. Unfortunately, it is often not noticed or treated properly. As a Breastfeeding Medicine physician, I see untreated breast swelling in many of my patients. This causes a lot of predictable, preventable lactation problems and suffering. Today, let’s review why breast swelling matters for lactation and how to get rid of it.
Swelling in the breast in the first weeks postpartum does NOT occur inside the milk-making cells and milk ducts in the breasts. It is mainly occurring in the delicate tissue surrounding this glandular and ductal tissue. That is why you can’t just suck the swelling out by pumping. You have to use very gentle methods to decrease the inflammation and swelling.
Ankles commonly swell in the early postpartum period. So does breast tissue. This swelling is often worsened due to getting IV fluids during labor and delivery. You often need more IV fluids when you have an induction, epidural, or c-section. This IV fluid may not be avoidable in these situations, so learning how to recognize and treat any resulting breast swelling is important.
The initial breast swelling often gets worse between day two to five postpartum. This is when blood flow increases to the breast, signaling your breast to increase mature milk production. Breast swelling, called ‘engorgement,’ occurs when the increased blood flow leads to swelling in the delicate areas around the milk-making tissue and milk ducts. Engorgement causes swelling, a sense of fullness, and often discomfort or pain in the breasts.
Breast swelling can cause several problems for breastfeeding and lactation:
- Breast pain: This is a common cause for parents to stop breastfeeding before they want to. Many parents think they have to suffer through pain because it is ‘normal’ – this is NOT the case. Pain in breastfeeding may be common, but it is never normal and should never be ignored.
- Difficulty latching and removing milk from the breast: Swelling in the nipple and areola make achieving a deep, comfortable latch more difficult. When swollen tissue presses against the delicate milk ducts, it makes it much harder for milk inside the ducts to find its way out of the breast.
- Decreasing milk supply: When milk cannot leave the breast, your body thinks it does not need to make as much milk. This results in decreasing milk production if the issue is not fixed.
- Parent Anxiety and Frustration: Many parents get told their nipples are flat when they are just temporarily flattened by breast tissue swelling. This leads many parents to believe they cannot directly breastfeed or that something is wrong with their bodies. The truth is that swelling is treatable, and we can help with techniques to improve the latch in the meantime.
- Needless Nipple Shield Use: Many parents are given a nipple shield in the first few days of breastfeeding as soon as they have any difficulty getting their baby to latch on the breast. This may seem harmless, but there are downsides to using nipple shields, especially when the actual problem is fixable with proper care. If the underlying problem is swelling, we should be treating the underlying problem of swelling, not trying to mask it up with a little cover and potentially cause more problems than we solve down the road. You can download a free handout on nipple shields here.
Luckily, there are some simple steps you can use to improve postpartum breast and nipple swelling. I suggest a four-step process called LIAR:
- L: Lymphatic Drainage
- I: Ice
- A: Anti-inflammatory and Anti-pain medicine
- R: Rest The Breast
Lymphatic Drainage: This is a very gentle massage that reduces swelling by promoting drainage of the swelling away from the breasts. Learn how by watching this demonstration video. The key is touching VERY GENTLY – your breasts are made of delicate glandular tissue and must be handled with care. Pushing too hard backfires by worsening the inflammation and swelling. Lymphatic drainage is so gentle that you will be surprised it works at all – but it is truly one of my favorite methods to treat swelling in the breasts. As soon as you have any breast swelling, start doing lymphatic drainage before every nursing or milk expression session. You can also use this technique anytime you feel uncomfortable or too full in your breasts. It may take just a few minutes to feel softening of the breast tissue, but it sometimes takes longer. The more severe the swelling, the more often you may need to perform lymphatic drainage.
Ice: Place a cold compress on the breast tissue as often as needed. This shrinks the blood vessels going to the breast tissue, which results in decreased swelling. Add this to lymphatic drainage sessions for maximum improvement. Be sure to place a thin cloth between the ice and your skin, and only place it on the breast for a few minutes at a time.
Anti-Pain Medicine: Medications like ibuprofen and acetaminophen will not make the swelling get better, but they may decrease any pain associated with the swelling and help you feel more comfortable while you treat the problem. Be sure discuss whether these medicines are appropriate for you with your own doctor and medical care team.
Rest the Breast: Knowing what NOT to do is one of the most important treatment steps for breast swelling. Many common tips for breast swelling and ‘plugs’ are actually terrible ideas and may even worsen your discomfort and swelling. So here’s a list of things NOT to do.
Do NOT:
- Firmly massage or press on the breast
- Use a vibration tool to push swelling out of the breast
- Use a breast pump for extra sessions or for an extra long session to ‘fully empty’ the breast beyond what your baby needs to eat because this can worsen swelling and cause you to produce too much milk (Note: it is ok to pump if you cannot feed your baby at the breast, or if your baby can’t nurse effectively at the chest)
- Turn your breast pump up to high suction levels to help ‘suck out a plug’ or remove swelling.
- Use a silicone one-piece pump to frequently remove milk or decrease swelling.
- Wear a tight, compressive bra (a properly fitting, supportive bra is just fine, though!)
- Use salt water or epsom salt soaks to the nipple.
- Push through the pain without getting help (pain with breastfeeding and pumping is common, but it is NEVER normal and should not be ignored)
- Dangle feed or have your partner ‘suck out the clog’ to decrease swelling
- Use constant heat to the breast (but it is ok to use it for a couple of minutes just before nursing or pumping if it helps you get a letdown)
You can download a free handout with these tips here. Don’t be frustrated if the breast and nipple swelling doesn’t go away immediately. It can take a few days, or even weeks if the swelling is severe, for things to resolve. See your lactation care team for more help whenever needed. And now that you know how to fight postpartum breast swelling, spread the word to your friends, family, and doctor.
Medical Disclaimer: This is general information and is not to be used as individual medical advice. Please always talk with your physician and your healthcare team before making any medical decisions for yourself and your baby.
