Puerperal breast engorgement

Specialty: Gynecology and breast.

• Mammary plethora
• postpartum breast engorgement
• hard and painful breasts during breastfeeding
• painful milk rise

Why it occurs

• Obstruction of milk ducts
• Milk retention due to ineffective breastfeeding technique or insufficiently frequent feedings
• Initial milk hyperproduction after calving
• Rapid weaning or abrupt interruption of breastfeeding
• Breast tissue edema secondary to intrapartum intravenous overhydration

Initial workup

Detailed clinical evaluation of breastfeeding technique (grip, position, frequency of feedings). Emergency breast ultrasound only if the formation of a breast abscess is suspected due to the presence of a fluctuating, painful and erythematous area that does not resolve with emptying measures.

Standard management

• Ibuprofen 400-600 mg orally every 8 hours — analgesic and anti-inflammatory of choice, compatible with breastfeeding
• Paracetamol 1000 mg orally every 8 hours if NSAIDs are not tolerated
• Cabergoline 0.5 mg (two 0.5 mg tablets in a single dose or 0.25 mg every 12 hours for 2 days) only if the complete medical inhibition of lactation is firmly decided for medical or personal reasons (note: apply local moist heat before feedings to promote the release of milk and local cold after feedings to reduce tissue edema).