The decision not to breastfeed begins the process of lactation suppression, where the body signals its milk-producing system to shut down. This involves managing the physical changes that occur when milk “comes in.” Following delivery, the rapid drop in pregnancy hormones releases the brakes on prolactin, the primary milk-making hormone. This hormonal shift initiates the production of mature milk (lactogenesis II), which typically causes the breasts to feel full and heavy around three to five days postpartum.
The Physiology Behind Milk Production Stopping
Milk production operates on a supply-and-demand system regulated by the Feedback Inhibitor of Lactation (FIL). FIL is a whey protein synthesized within the mammary epithelial cells and secreted into the milk ducts. When milk is not removed, this protein accumulates in the breast tissue. The buildup of FIL acts as a localized signal to slow down the milk-secreting cells, effectively telling the breast to halt production.
The lack of milk removal also causes the milk-producing cells (alveoli) to become distended. This sustained pressure and the presence of FIL lead to a downregulation of prolactin receptors, making them less responsive to the circulating hormone. This localized, self-regulating mechanism, known as autocrine control, ultimately drives the cessation of milk production. The lack of demand signals the body to begin the process of involution, or shrinking of the milk-producing tissue.
Expected Timeline for Milk Cessation
The timeline for complete milk cessation is individual and depends on factors like the amount of milk produced and whether any expression occurs. For women who choose not to breastfeed, intense breast fullness (engorgement) usually peaks around the fourth postpartum day. It then gradually subsides over the next ten to twelve days as the body adjusts to the lack of milk removal.
While the discomfort from engorgement may resolve within the first one to three weeks, the complete drying up of milk takes much longer. Most women find their milk supply significantly drops within two to three weeks, though expressing a few drops for weeks or even months afterward is not uncommon. Suppression relies on consistently avoiding stimulation and expression to allow the FIL mechanism to work fully.
Comfort Measures During Suppression
Managing engorgement is a primary focus during lactation suppression to maintain comfort and prevent complications.
Supportive Garments
Wearing a firm, supportive bra around the clock is an effective strategy to provide compression and reduce breast movement, minimizing stimulation. The bra should be supportive but not overly tight. Excessive compression or binding is no longer recommended, as it may increase the risk of blocked ducts.
Cold Therapy
Applying cold therapy helps reduce swelling and numb the painful sensations associated with engorgement. Ice packs or frozen vegetables, wrapped in a cloth, can be applied to the breasts several times a day for short periods. Some people find relief by placing chilled, fresh green cabbage leaves inside their bra, changing them every few hours once they wilt.
Pain Management and Expression
Over-the-counter anti-inflammatory pain relievers, such as ibuprofen, are helpful for managing pain and inflammation. Express milk only sparingly, if at all, to relieve intense pressure, but do not fully empty the breast. Removing too much milk signals the body to continue production, prolonging the suppression process.
Recognizing Complications
While suppressing lactation, there is a possibility of developing inflammation or infection that requires medical attention. Mastitis is an inflammation of the breast tissue that occurs when milk stasis leads to inflammation and potential infection. Symptoms often appear suddenly.
Symptoms may include a localized area on the breast that is hot, painful, and red, though redness can be harder to see on darker skin tones. This inflammation is frequently accompanied by flu-like symptoms, such as body aches, chills, and a fever of 100.4°F (38°C) or higher. If these symptoms develop, or if a tender, hard lump (indicating a plugged duct) does not resolve within a day, a healthcare provider should be contacted. Untreated, severe mastitis can lead to a breast abscess, a painful collection of pus that requires draining.