reabsorption of the residual milk.1 The increase in intraductal pressure causes the residual milk to undergo an intermolecular transformation, and to become thicker.2
It is important to distinguish between physiological and pathological engorgement. The former is discrete and is a positive sign that milk is coming in. It requires no intervention. In pathological engorgement, there is excessive tissue distension, causing great discomfort, sometimes accompanied by fever and malaise. The breast is bigger, painful, with diffuse shiny reddish areas, and edema. Nipples become flat, hampering proper latch-on, and milk sometimes does not flow normally. This type of engorgement often occurs around the third to fifth day after delivery and usually is associated with one of the following factors: late initiation of breastfeeding, infrequent breastfeeding, restriction on the duration and frequency of breastfeeding, use of complementary foods, and babies with poor suck.3
Engorgement may affect only the areola (areolar engorgement) or the main body of the breast (peripheral engorgement) or both. In case of areolar engorgement, latch-on may be hindered, preventing the proper emptying of the breast, which increases engorgement and pain.