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.