Diane Wiessinger wrote about Jean Cotterman's technique for dealing with
engorgement: having the mother press around the base of the nipple with her
circled fingertips for 1-2 minutes.  Here are my thoughts.

Several women I encountered while working as a hospital LC had areolar tissue
I would describe as "tough."  Often their breasts were especially firm---this
would be on Day One or Two, too early for what we would consider "typical"
engorgement.  One mother commented on the change; her breasts had been soft
and flexible all through pregnancy, but now she didn't recognize them!  The
nipples were usually firm also, unyielding, inflexible.  Not anything you'd
think a baby could manage, especially a baby who was getting to the breast
for the first time several hours after birth.  (Now you know how
Baby-Unfriendly the conditions were at my institution!)

In an effort to interest the baby, we would try to express some drops of
colostrum.  Usually the mother had never done this before and would not be
comfortable doing it, so I would do the expressing.  After expressing just a
few drops---maybe about six---the areola would become softer and the nipple
would be more flexible.  Sometimes I could see the prints of my finger and
thumb as depressions in the areola when I took my hand away---pitting edema
of the areola??!!  So I surmised that the firmness we were dealing with was
caused by edema in these moms.  The pressure from the manual expression must
have pressed the extracellular fluid back into the breast.  The change in
tissue texture was more than could be explained by the small amount of
colostrum that we actually removed from the sinuses.

Ever since developing this theoretical explanation for the phenomenon I was
observing, I have wanted to go back to the books and review the changes in
physiology of body fluids around the time of birth.  I know that fluids
migrate from place to place in women's bodies.  If other extremities, such as
feet and hands, can be swollen, then breasts can be too.  The trouble with
edema in the nipples and areolae is that it presents the baby with a big
challenge!   All the more reason to have the baby nursing soon and often.
 For two reasons: one, the baby learns how to latch on BEFORE the areola has
a chance to develop edema; two, if the baby is nursing (that is, compressing
the nipple and areola rhythmically and repeatedly), perhaps the build-up of
fluids in the areola can be PREVENTED.  I mean...if my fingers could change a
tough breast to a soft breast, how much better would the baby's mouth be at
the same job!

I also speculated that the women who had this problem may have been given
more IV fluids than the average patient---but I never got the time to review
charts to see whether this was true.  Or they may have been women who were
slower to diurese after giving birth.

Those of you who work with post partum mothers might want to look into this.

Chris