When thinking about cold versus hot treatment for engorgement, I believe
it's important to differentiate WHEN it is occuring--primary engorgement
(at the onset of lactogenesis II) versus "congested" engorgement that
occurs later in lactation. In primary engorgement, much of the swelling in
the breast comes from fluid overload throughout the tissues of the breast
(as someone already pointed out). There is a "traffic jam" in the breast as
the consequence of a physiologic process. I find that cool/cold treatment
applied consistently after feeding/expressing milk reduces swelling and
relieves pain in primary engorgement.

By contrast, in congested engorgement, it's my understanding that the
fullness in the breast is due largely to packed milk glands; typically this
happens when milk has not been removed for a lengthy period for whatever
reason. So in this case the goal should be to remove milk thoroughly; a
little warmth applied as needed (usually 5 minutes or less) to aid in
letdown/milk flow is helpful. Mothers usually tell me the thing that
brought relief in this instance was to "empty" the breast as well as
possible. A prior poster mentioned overhearing that cold would suppress
milk supply in an engorged breast; it seems more likely that it's simply
milk stasis that supresses production, the mechanism we're already familiar
with.

Julie-Ann Toalston, IBCLC
Connecticut, USA

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