VAL:
 In response to your post, based on what you wrote, I agree that the breast
should be kept well drained. My rationale is as follows: 1. Engorgement is
swelling and lymph stasis from too much milk left in the breast to begin with.
Moving milk out is the solution. Not moving it only complicates matters; and
2. Since part of the problem with engorgement is lymph stasis, removing milk
from the breast causes MER. The oxytocin not only acts on the smooth muscles
of the parenchymal myoepithelia but also on the smooth mucles of the lymph
vessels causing the lymph to function better. This in turn clears out the
"stuff" that collects in the extracellular spaces and helps to speed
resolution of engorgement.

I learned this last tidbit in my lymph drainage class from Dr. Chickly. I was
thrilled to have one more rationale justifying keeping the breast stimulated
via baby and/or pumping, even if there is not much milk that comes out at
first.

Additionally, I would recommend using ice, not heat, to help further reduce
the swelling associated with engorgement milk stasis. Cryotherapy is of proven
benefit with swelling, as we all know. It works superbly for engorgement too!
And quickly!

Alison K. Hazelbaker, MA, IBCLC