Initial Pain Levels, Engorgement, and Plugged Duct Severity To test our primary hypothesis that in-office TBML results in a significant decrease in acute breast pain, we assessed baseline breast and nipple pain in the 24 hours preceding the office visit, pain duration, and pain on examination (Table 2). Initial mean (SD) breast pain for the entire sample was 6.43 (2.5). Median duration of pain before office visit was 24 to 48 hours for engorged mothers and 72 to 96 hours for MPD (P = .013). On examination, mothers with engorgement compared to MPD had higher levels of both breast tenderness (8.27 vs 6.5, P = .041) and nipple tenderness (6.93 vs 4.3, P = .021). Ninety-three percent of engorged mothers presented with periareolar swelling. Engorgement severity was recorded on both breasts. Each breast was considered independently for a final sample of 30. On the Humenick engorgement scale, 53% were very firm, very tender. Initial evaluation of plugged duct severity revealed that the swollen area measured greater than 5 cm for 36% of cases (Table 2).