A Case Study of Early Postpartum Excessive Breast Engorgement: Is it Related to Feedback Inhibition of Lactation?

Introduction There is limited information about problems of feedback inhibition of lactation which should be considered as a rare cause of breast engorgement. We report the management of excessive breast engorgement in a mother with a presumptive diagnosis of a defect in the feedback inhibition of lactation. Main issue The participant, who had been discharged on postpartum Day 2 while breastfeeding her infant, was readmitted to the hospital the next day with engorgement of the breasts and cessation of milk flow. Pumping and application of cold dressings alone did not work effectively. The severity of the symptoms decreased only after the addition of an anti-inflammatory drug and a prolactin inhibitor. Management The participant received breastfeeding counseling, family-centered care, and support for pumping equipment. An anti-inflammatory drug was started and a low dose prolactin inhibitor was given. The difficulty was the management of extensive and painful breast engorgement and the re-establishment of milk flow. At postpartum Day 14, the participant and her infant were discharged with effective breastfeeding status. Conclusions The recognition of a problem in the feedback inhibition of lactation as a cause of breast engorgement is important because it may be unresponsive to classical treatment methods resulting in cessation of milk flow. With the cautious use of low-dose cabergoline, in addition to other treatment strategies, milk flow can be reduced in a controlled manner while ensuring the continuity of milk production. An early diagnosis, interdisciplinary approach, and a close follow-up of the mother-infant pair are essential for preserving lactation.