Breast changes and conditions

Reviewed by SickKids Staff Last updated: February 3rd 2020

Read about the changes that your breasts will go through after childbirth, and
various breast complications that can interfere with breastfeeding your baby.

Key points
The best way to prevent breast complications while lactating is to stimulate and empty
the breasts on a regular basis, at least eight times in 24 hours.
Breast engorgement can be common a few days after birth.
Unresolved engorgement or a plugged milk duct can lead to an infection and/or a low milk
supply, so it is important to treat these as soon as possible.
Pain, redness and flu-like symptoms usually indicate a breast infection (mastitis) that may
need medical treatment.

The terms 'mother' and 'breastfeeding' are used throughout our

documents; we recognize and respect that individuals and families

may use other preferred terminology.

Breast changes after childbirth

Your breasts likely became tender and larger during pregnancy, as
they prepared to make milk for your baby. Typically, within the first
week after childbirth, you will feel further changes in your breasts
as they start to produce more milk. These initial changes happen
regardless of whether you are breastfeeding or not, due to
hormonal changes that occur at delivery. After this stage, your breasts will continue to produce milk if
you stimulate and empty the breasts on a regular basis. This demand and supply concept of breast
milk production is maintained by breastfeeding your baby frequently. When your baby cannot
breastfeed, you can maintain milk production by breast pumping. The following complications may
occur while you are lactating, especially if your baby is not feeding effectively or you are not
emptying your breasts often enough.

Breast engorgement

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 When your milk comes in between day three and five after birth, your breasts may become full, firm
and uncomfortable. This is called breast engorgement. Engorgement is when there is swelling and
increased pressure in the breasts due to an accumulation of breast milk and other fluid (interstitial
fluid, lymph and blood).

Breast engorgement

Symptoms
The whole breast feels hard, heavy and tight
Breasts may have some redness and shine
Tenderness
Usually both breasts are affected

Causes
The breast is not emptied for a long period of time
The baby is not latching or drinking effectively
It is part of the natural process of milk production in the first three to five days after delivery

Treatment
The most important strategy for relieving engorgement is frequent and effective milk removal from
the breasts. You should breastfeed or breast pump at least eight times in 24 hours to help relieve
engorgement and maintain your milk supply. Wear a well-fitted maternity bra for support.

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 Sometimes the swelling in the breast tissue during engorgement can be so severe that it stops the
milk from flowing. It is important to treat this swelling as soon as it starts to occur:

Apply a cold compress to your breasts for

20 minutes after or in between breastfeeds
or pumping sessions to reduce swelling.

Only apply heat for a few minutes just

before feeding or pumping if you are able
to express some milk.

Lie down and massage your breasts, pushing towards the arm pits.
If needed, take an anti-inflammatory (such as ibuprofen) to control the pain and to reduce swellin

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 As indicated by the blue arrow, push fluid from nipple to
armpit.

Reverse pressure softening

If your areola (the dark area around your nipple) is swollen and this
is interfering with milk flow and/or latching, you can do reverse
pressure softening before feeding or pumping. You do this by
placing the tips of your fingers on the areola and applying pressure
for 60 seconds. This helps to soften the areola, which makes
latching or pumping easier.

It may be helpful to do this while lying down to help with

fluid drainage.
You can also refer to the International Breastfeeding Centre
for more information on this technique.
A lactation consultant can help you if you require assistance.
As indicated by the blue arrow, press
inward toward the chest wall, with
fingertips touching the side of the
nipple.

You may find hand expressing is also helpful to soften the areola enough for effective latching and
pumping.

Plugged milk ducts

A plugged duct is an area in the breast that is not draining well, causing a blockage.

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 Plugged duct

Symptoms
Tender lump, or lumpy area in the breast—this is different from engorgement, as there is
hardness in just one area of the breast
Area may look red or feel warm
Decreased milk flow from affected breast
You otherwise feels well overall

Causes
The baby is not latching well
The baby is feeding less than usual due to illness
Feeds or breast pumping sessions have been missed or shortened
Tight restrictive clothing; wearing an underwire bra
Sleeping on your tummy or more on one side

Treatment
The most important strategy for relieving a plugged duct is frequent and effective milk removal from
the breasts. You should breastfeed or breast pump at least eight times in 24 hours.

A key element to treatment is removing the blockage to allow milk to flow. You can do this in the
following ways:

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 Apply heat (moist heat tends to work best).

Massage in a circular or downward motion

from behind the lumpy area towards the
nipple.
If breastfeeding, massage during the
feed. Try breastfeeding in positions
where the baby’s chin or nose are
pointing towards the affected area.
If pumping, massage during the
pumping session.

As indicated by the blue arrow, push from behind blockage

toward nipple.

Try hand expressing after pumping to fully empty the breast.

If needed, take an anti-inflammatory (such as ibuprofen) to control the pain and to reduce
swelling.
Wear the right sized bra (no underwire); loosen the bra to prevent compression of the milk
ducts.
Take care of yourself—rest, eat, drink.

An plugged duct can lead to mastitis. If symptoms do not resolve using the suggested treatments,
seek medical attention.

Mastitis
Mastitis is inflammation of the breast tissue, sometimes occurring with an infection.

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 Mastitis

Symptoms Mastitis

A red area on the breast—there can be red streaks : Breast appearance

Breast pain
Flu-like symptoms such as fever, chills, fatigue, general
aches and pains
It usually affects only one breast
Decreased milk supply on the affected side

Causes
Inadequate emptying of the breast, caused by:
Infrequent feeding or pumping
Persistent engorgement or a plugged duct
A poor latch
Restricting feeding times
An oversupply of milk
Rapid weaning

Other causes or risk factors are:

Bacteria, often entering through a crack on the nipple

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 Illness in the mother or infant

Treatment
The most important strategy for relieving mastitis is frequent and effective milk removal from the
breasts. You should breastfeed or breast pump at least eight times in 24 hours.

Early mastitis with mild symptoms can be treated conservatively:

Breastfeeding should be continued during this time. If your baby is not feeding at the breast,
replace feeds with pumping until your baby returns to the breast.
If breastfeeding, try different positions, including ones where the baby’s chin or nose
are pointing towards the affected area.
Your milk supply may drop significantly on the affected side, even with frequent
emptying—try not to worry. Keep emptying your breasts, and your milk supply will
likely return to normal once the mastitis clears.

Apply cold compresses for 20 minutes in

between feeding or pumping to reduce
pain and swelling.

Place warm compresses on the affected

breast for a few minutes before feeding or
pumping to promote milk flow.

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 Massage the blocked area in a circular or
downward motion during pumping or
feeding.

As indicated by the blue arrow, push from behind blockage

toward nipple.

If needed, take an anti-inflammatory such as ibuprofen.

Take care of yourself—rest, eat, drink.
Reach out for support to decrease stress and fatigue.

If you have a high fever, or if symptoms worsen or do not improve after 24 hours, seek medical
attention immediately from your family doctor or closest emergency department: you may need
antibiotics or further investigation of your symptoms.

Most antibiotics are safe with breastfeeding—discuss with your doctor, pharmacist, or call Telehealth
Ontario’s 24/7 breastfeeding line.

Prevention
The best way to prevent breast complications while lactating is to empty the breasts frequently.

If you are breastfeeding, feed on demand and ensure a good latch for effective milk removal.
If you are pumping, pump both of your breasts at least eight times in 24 hours, and ensure
proper flange fit and settings.

Hygiene:

Wash hands frequently, especially if you have a crack or abrasion on your nipple or breast.
Clean and sterilize your pump kits according to manufacturer instructions.
Change breast pads frequently when wet, at least once a day.

Where to get help

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 All of these breast complications are associated with ineffective milk removal from the breast. It is
strongly recommended that you see a lactation consultant as soon as difficulties arise to ensure the
baby is feeding effectively, or for a pumping assessment.

You can also seek help from these other health-care professionals and resources, especially if mastitis
is suspected:

A family doctor
An obstetrician or midwife
A walk-in clinic
Telehealth Ontario’s 24/7 breastfeeding line: 1-866-797-0000 | TTY : 1-866-797-0007
An emergency department (for mastitis not responding to conservative treatment)

Additional Resources
To watch a video on common breast complications during lactation, please visit:
http://www.sickkids.ca/breastfeeding-program/videos/index.html.

For further resources on breastfeeding and lactation, please visit:

http://www.sickkids.ca/breastfeeding-program/index.html.

Please visit AboutKidsHealth.ca for more child health information.

©2023 The Hospital for Sick Children

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