What are the main signs and symptoms of breast engorgement?

When the breasts are engorged with milk and swollen, some common signs and symptoms appear in one or (more often) both breasts. The breasts can feel firm, tender, tight, painful, warm, and even lumpy. They will look larger, can be uneven or lopsided, and the skin covering them may appear shiny (due to being stretched) and have more visible veins. The swelling sometimes extends to the armpit or across the sternum and can also affect the nipples, making them firm and flat (or even inverted).^[1] Systemically, a mildly elevated body temperature may be present.^[2] These signs and symptoms can ebb and flow, remain constant, or progressively worsen with time.^[3] It is considered normal to experience some degree of breast engorgement in the first week after giving birth.^[4]