Early breastfeeding comes with a steep learning curve, and breast discomfort can spike your stress fast. What are the differences between Engorgement, plugged ducts, and mastitis? They can feel similar at first, but each one follows a different pattern. When you can tell them apart, you can respond with more confidence and get help sooner when you need it. Keep reading to explore the differences between them.
Engorgement
Engorgement usually shows up when milk comes in or when feeds get delayed, and your breasts overfill. Both breasts often feel heavy, tight, and hot, and the skin can look stretched or shiny. Your nipples may flatten, which can make latching harder and add to the frustration.
Engorgement tends to improve after frequent milk removal. Gentle warmth before a feeding can help milk flow, and cool packs afterward can calm swelling. If the areola feels too firm for the baby to latch, hand-expressing a small amount can soften the area.
Plugged Ducts
A plugged duct tends to feel more specific, like a tender lump or thickened spot in one area of one breast. You might notice a sore wedge-shaped section or a spot that hurts more during letdown. You can still feel well overall, even if the breast feels irritated.
Plugged ducts often link to pressure, skipped feeds, tight bras, or sleeping in a position that compresses tissue. Midwives teach new parents about breastmilk and often mention that steady milk removal and gentle comfort measures usually help. Feeding on the affected side, varying positions, and light massage during a feeding can support flow.
Mastitis
Mastitis can start as lingering duct inflammation, but it often brings stronger symptoms. You may feel feverish, achy, and wiped out, with a painful, red area that can spread. One breast may throb, and the skin may feel hot and look angry.
With mastitis, rest and hydration matter, and you still want regular milk removal if feeding feels possible. Call a healthcare provider promptly if you run a fever, symptoms ramp up quickly, or you see no improvement within a day. You deserve quick relief, and treatment can help you recover and protect your milk supply. If you can’t breastfeed, I highly recommend getting a good breast pump (aff link). A good breast pump will help alleviate the engorgement and get the infection out. However, your baby is very efficient at getting the milk out of the breast.
Trust the Pattern, Not Just the Pain
Pain alone does not tell the whole story. Engorgement usually feels widespread, plugged ducts feel focused, and mastitis often comes with systemic illness. If you feel uneasy, reach out to a lactation consultant, midwife, or clinician and describe the pattern you notice. Support counts, especially when your body feels like it has its own agenda.
