During lactogenesis II (30-40 hours after birth), copious milk production occurs and initial engorgement may be felt. Breasts may become larger, heavier, tender and/or unbearably hot. Engorgement can be more severe if breast edema (fluid retention in the breast) is present or occurs simultaneously with the rapid rise in milk volume. Initial engorgement is not to be confused with milk stasis.

Milk stasis or breastmilk retention is an uncomfortable breast fullness that can occur at any time during lactation when excess milk remains in breast. Caused by ineffective and/or infrequent removal of milk. Prolonged milk stasis triggers involution and can become irreversible as the lactoctyes that are necessary for milk synthesis are deactivated or destroyed. Milk stasis can also lead to plugged ducts and mastitis. With frequent feeding and effective milk removal, it is normal even if breasts feel soft all the time. Extreme engorgement can damage milk supply!

Tips if you are suffering from engorgement or milk stasis:

• Roll nipples and areola to ensure patent pores, hand express till area is softer for baby to latch.
• Apply cold compress or frozen cabbage leaves on hard and painful breast to soothe and reduce swelling. Applying heat to swollen breast tissue without milk removal is NOT appropriate as heat stimulates. 
• Feed baby frequently or drain breasts with hand expression. Hand expresion is more effective and often more comfortable than pumping (Ohyama et al., 2010; Parker et al.,2012)

If engorgement persists for more than 48 hours with or without fever, you may wish to see your doctor/ lactation consultant to rule out other causes.