Written by Dr.M.D.Mazumdar, MD
Breast engorgement is defined as the occurance of painful overfilling of the breasts when the amount of milk produced is more than the amount of milk removed from the breast. It is an imbalance between milk production and milk demand.
Breast engorgement usually occurs on the 3rd or 4th day of the postpartum period when the milk production in the breasts changes from colostrum to mature milk.
Each breast gland is composed of 20 lobules that are drained by 20 lactiferous ducts. These ducts open on the tip of the nipples.
Milk is formed in the lobules from the mother's blood and carried by the lactiferous ducts to a structure called the ampulla where some of the the milk is stored. The initial milk that is sucked by the baby comes from the ampulla and the later part from the lobules.
Immediately after the baby is delivered, and for another for 3 - 4 days, the breasts secrete a thin yellowish liquid called the 'colostrum'. The amount of colostrum secreted is adequate for the baby in these 3-4 days.
But as the baby's need increases and suckling becomes more vigorous, there is increased production of milk in the baby. At this time, there is a 'let down' reflex in the pituitary glands in response to the suckling of the breast by the baby. The baby may be unable to suck out all the milk from the breast causing milk to collect and stagnate in the breast lobules. This leads to engorgement of the breasts.
Another cause for breast engorgement is an increased blood supply to the breasts at this time.
The increased blood supply to the breast causes engorgement of the breast tissues which presses on the ducts, damming the milk in the lobules. As the breast tissue gets more and more engorged, it pulls on the nipple, flattening it, or even inverting it. The inversion of the nipple may prevent the baby from suckling vigorously, causing more engorment.
Both increased blood supply and stagnation of milk are responsible for breast engorgement.
Infection can occur readily in the stagnant milk since milk is a very good media for the growth of bacteria. this can lead to breast infeciton ('Mastitis') or even breast abscess.
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The symptoms of breast engorgement may be very similar to those of a condition known as Inflammatory Breast Cancer (IBC). This is a particularly aggressive type of breast cancer. So, if any of the above symptoms appear, they should not be neglected and dismissed as a simple breast engorgement. A thorough medical check up is always necessary to rule out IBC.
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