Pressure in the breast induces apoptosis in any overfull lactocytes. 
(They release their attachment to the basement membrane through an 
integrin protein, and no longer get a survival signal, and then 
apoptose). Pressure also reduces immediate milk production by 
interfering with the geometric arrangement of organelles, especially 
ribosomes, so protein production ceases. (Think hammering a machine so 
the parts no longer line up - it no longer functions.) Milk production 
is decreased over time when fewer lactocytes survive than are 
regenerated by proliferation based on milk removal and prolactin 
spiking. Therefore, I recommend pumping if RPS and getting the baby to 
feed more often don't clear engorgement. We see really reduced milk 
production if a mom doesn't get the engorgement cleared out, and pumping 
to relieve engorgement doesn't seem to increase supply overmuch. In any 
event, oversupply can be managed by block feeding later, but undersupply 
means exposing the baby to artificial milk. Engorgement is not normal, 
babies should feed very often, and engorgement should not occur. It's a 
non-physiologic response to our non-physiologic breastfeeding management.

I want to make it clear I'm not talking about breast fullness here that 
moms experience when lactogenesis II kicks in, but uncomfortable 
engorgement that makes it more difficult to get milk out. I also 
recommend ice or cool compresses right before pumping, feeding, or 
manually expressing to reduce some of the surface edema and allow milk 
to flow more readily.

Catherine Watson Genna, BS, IBCLC  NYC

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