Breast edema is the congestion and swelling of fluids in the interstitial tissue between the milk ducts. While the swelling can look similar to engorged breasts (and can lead to misdiagnosis), the two have entirely different causes and solutions. Breast edema typically occurs during the first few days postpartum, before transitional milk comes in, and is experienced more commonly among those who received excessive intravenous fluids during labor.

What it is

Because both involve swelling and congestion, breast edema and engorgement are often confused for one another. But edema is actually a swelling of the interstitial tissue between the milk ducts. When you have breast edema, your breasts can look pitted like an orange peel, or puffy and easily indented. (When the milk ducts themselves are congested, as with engorgement, the breasts become taught and warm.)

When it can occur

Breast edema almost always develops in the first one to four days postpartum, before engorgement typically sets in. If your breasts feel swollen a day or two after delivery, this may be a sign that you have edema instead of engorgement. Leg edema—or swelling of your legs—often accompanies breast edema.

What causes it

Breast edema is more common among women who received excessive intravenous fluids during labor. The fluid retention and bloating from birth interventions can lead to congestion of fluids in the interstitial breast tissue. Blood pressure dysregulation (abnormal swings in blood pressure) can also lead to breast edema, and can be fatal if not immediately treated.

What to do

Ideally, a lactation consultant will do an evaluation in the first days following birth to analyze symptoms and differentiate between engorgement and edema, because the treatment of one can exacerbate the other. Your blood pressure should be closely monitored, and a lactation consultant should ensure that your baby is latching properly to encourage milk production and flow, which may be constrained as the interstitial breast tissue swells and compresses your milk ducts.

Avoid pumping at first, because the pressure draws excess interstitial fluid toward the areola. Instead, hand-express using reverse pressure softening¹ to manually push the edema back. Think of it as massaging the bloating away from your nipple so that you can feel the regular tissue. For help on the technique, refer to the below guide, or consult a lactation specialist, and schedule an in-person visit or televisit for as soon as possible.