True breast engorgement is an overfilling of breasts with milk - above and beyond the breasts feeling full, as is often the case in the first few weeks of breastfeeding.
Engorgement is when the breasts are abnormally distended, either from swelling known as edema (this can happen when mom has mastitis, for example) or from milk not being properly removed from the breast. This tends to happen when the mother skips feedings, waits too long between feedings, or does not feed to express enough milk out. Also, abruptly stopping breastfeeding can cause engorgement.
Engorged breasts tend to feel hard, stiff, and, sometimes, like there are rocks inside. The breast may feel tender, sensitive, and have some reddish areas. The areola is also hard instead of soft, as it should be. Some mothers may suffer from low grade fevers.
Reviewed by Dr. Jen Lincoln, March 2020