Breast Shaping and Compression Techniques
Breast shaping and breast compression are hands-on techniques that can support breastfeeding by helping an infant attach to the breast and improving milk transfer. They may be useful when an infant is not gaining weight as expected, when milk intake needs support or when milk production needs to be maintained or increased. The two techniques can be used separately or together, depending on the needs of the feeding dyad.
These techniques can be particularly useful following tongue-tie division. An infant who has previously had restricted tongue movement may need time and support to develop more effective tongue and jaw movements and to establish comfortable attachment. Supporting and shaping the breast can help reduce the weight of the breast against the infant's chin and lower jaw, allowing the chin to move forwards. Breast compression can encourage milk flow while the infant is developing more effective feeding patterns. Smyth (2017) discusses breast shaping as one approach that may be helpful for infants with tongue restriction. These are practical feeding techniques, rather than a guarantee of improved feeding outcomes following division.
They are not only relevant after frenulotomy. Breast shaping may be helpful when the breast is full, rounded, heavy or difficult for an infant to grasp, or when the nipple is relatively flat. Breast compression may be useful when an infant becomes sleepy at the breast, sucking continues but swallowing slows, or additional milk transfer is needed.
Breast shaping
Breast shaping involves gently supporting and compressing the breast to help an infant take a mouthful of breast tissue when attaching. The aim is to make the breast easier to grasp, with its shape aligned to the direction of the infant's lips and mouth.
Why breast shaping may help
Breast shape, fullness and weight can all influence how an infant approaches and attaches to the breast. Smyth (2017) describes breast shaping as a way of supporting the breast and adjusting its shape to help an infant take a mouthful of breast tissue. This may be particularly useful where the breast is rounded, the nipple is relatively flat or the infant needs additional support to achieve attachment.
Where the breast is large or heavy, positioning is also important. The weight of the breast against an infant's chin or chest may make it more difficult for them to bring their chin forwards and maintain a comfortable feeding position. Supporting the breast may help, but the infant's position and the way the breast is supported need to be considered together (Smyth, 2017; Douglas and Keogh, 2017).
Breast fullness and engorgement can create additional difficulties. When swelling makes the nipple and areola firm, an infant may find it harder to grasp the breast. Reverse pressure softening may help make the tissue around the nipple more pliable before attachment. This is different from breast shaping and is worth considering where engorgement or areolar oedema is contributing to the difficulty.
For more information, see Breastfeeding: latch and positioning and Reverse Pressure Softening Technique for Engorgement.
Breast shaping also supports the principle of bringing the baby to the breast, rather than moving the breast towards the baby and then releasing it. Moving the breast towards the infant can create tension or drag as the breast returns to its natural position. Supporting its shape while the infant attaches can help avoid this (Smyth, 2020).
Choosing a hand hold
The hand hold describes how the breast is supported; it does not describe the infant's feeding position. The direction in which the infant approaches the breast helps determine which hold may be most comfortable and useful.
C-hold: The thumb rests above the breast and the fingers below it. The thumb and fingers are positioned in line with the infant's lips. This may be useful when the infant is lying more vertically against the caregiver's body.
U-hold: The thumb and fingers support the breast from either side, with the hand positioned to align with the infant's lips. This may be useful when the infant is held across the body, such as in a cradle position.
Scissor hold: The breast is supported between the forefinger and middle finger, with one finger on either side of the nipple. This is another option where the shape and direction of the breast need gentle adjustment.
These are options rather than rigid rules. The most useful hold is the one that allows the breast to be supported comfortably and shaped in the direction that matches the infant's mouth (Smyth, 2017).
How to use breast shaping
1. Position the infant comfortably. Bring the infant close, with their body facing the caregiver and their head and body in alignment. Position them so that their nose is approximately level with the nipple.
2. Support the breast. Use a C-hold, U-hold or scissor hold, depending on the infant's position and the direction of their mouth. Keep your fingers and thumb far enough back from the nipple and areola to leave space for the infant to attach.
3. Shape the breast. Gently compress the breast so that its shape is aligned with the infant's lips. The aim is to make it easier for the infant to take a mouthful of breast tissue, rather than to push the nipple into their mouth.
4. Invite a wide mouth. Allow the infant to open their mouth widely before bringing them onto the breast. Their chin should make contact first, with the nipple directed towards the nose. This supports a chin-first approach to attachment.
5. Support the attachment. As the infant comes onto the breast, maintain the shape and support needed to help them take a comfortable, deep mouthful. A flipple technique may also be helpful for some feeding dyads. These approaches are discussed further in Breastfeeding: latch and positioning.
6. Settle into a comfortable position. Once the latch feels sustainable, the infant has established a secure seal and feeding is comfortable, allow yourself to relax your shoulders and arms. You can continue to support or hold the breast if this remains helpful; there is no need to remove your hand if doing so changes the infant's attachment.
Breast shaping should feel comfortable. It should not involve pulling the breast towards the infant, squeezing painfully or forcing the infant to attach.
Breast compression
Breast compression involves applying gentle pressure to the breast while an infant is feeding. This can encourage milk flow and help maintain milk transfer when an infant's sucking becomes less effective (Newman, 2017; Pearson-Glaze, 2023).
An infant may continue to suck without transferring much milk. Watching for swallowing, rather than relying on sucking movements alone, helps identify when milk is being transferred. Newman (2017) describes breast compression as a way of encouraging milk flow when an infant is sucking but is no longer drinking actively.
Recognising the signs of swallowing can help families understand when their baby is actively transferring milk during a feed. See Recognising Infant Swallowing During Feeds for more information about what to look for.
Why breast compression may help
Breast compression can encourage milk flow and may help an infant take more milk during a feed. It can be useful when swallowing slows, when an infant is sleepy or less active at the breast, or when there are concerns about milk transfer and weight gain (Newman, 2017; Pearson-Glaze, 2023).
Milk production is influenced by how frequently and effectively milk is removed from the breast. If breast compression helps an infant remove more milk, it may contribute to supporting milk production. However, breast compression alone cannot guarantee an increase in supply or weight gain. Feeding frequency, attachment, infant feeding ability and other factors also need to be considered (Daly and Hartmann, 1995; Pados and Camp, 2024).
How to use breast compression
1. Start with the infant attached. Allow the infant to attach and begin feeding. Observe their sucking and swallowing pattern.
2. Look for active milk transfer. When milk is flowing, you may see a pattern of sucking followed by a pause as the infant swallows. As swallowing slows or stops, the infant may continue sucking without taking much milk.
3. Apply comfortable pressure. Gently compress the breast while the infant is sucking but not swallowing effectively. Maintain the pressure while the infant is drinking, rather than repeatedly squeezing in time with every suck.
4. Release when swallowing slows or stops. Allow the infant to continue sucking and see whether active swallowing starts again. If it does, you can apply breast compression again when swallowing slows.
5. Adjust your hand position. You can move your hand to a different area of the breast if needed. Continue to use comfortable pressure and respond to the infant's feeding pattern.
6. Offer the other breast when appropriate. When the infant is no longer drinking actively from the first breast, you can offer the other side. Breast compression can be used there too, if it is helpful.
The amount of support needed varies. Some infants may need breast compression for only part of a feed, while others may benefit from it for much of the feed. Follow the infant's cues and allow them to pause, come off the breast or finish feeding when they are ready (Newman, 2017).
Two ways to apply breast compression
There is more than one way to position the hand when applying breast compression. The most important considerations are that the pressure is comfortable, the infant can remain attached and milk transfer is encouraged.
Flat-hand breast compression
Place the flat of your hand against the breast and apply gentle, broad pressure. This can be useful when a wider area of the breast needs support. Adjust the position of your hand as needed, while keeping pressure comfortable.
Breast compression using a C-shaped hold
Place your thumb on one side of the breast and your fingers on the other, forming a C shape. Apply gentle pressure between the thumb and fingers. This hand position can also be used for breast shaping, so the two techniques can overlap. The hand can be repositioned to find an area where breast compression encourages milk flow without discomfort.
The video demonstration by Jack Newman shows how breast compression can be used during a feed: Breast compression – Jack Newman.
Breast contact and pressure
There is no need to avoid touching or supporting the breast during feeding. Comfortable breast shaping and responsive breast compression are practical ways of supporting attachment and milk transfer.
This is different from applying excessive or uncomfortable pressure to one area of the breast for prolonged periods. The aim is to use pressure in response to the infant's feeding, adjusting or releasing it as needed. Research and clinical discussion about breast inflammation have considered sustained external pressure as one possible factor, but this should not be confused with ordinary, comfortable hand support during a feed (Douglas, 2022; Pearson-Glaze, 2023).
Using breast shaping and breast compression together
Breast shaping and breast compression can be used together. For example, a caregiver may first shape the breast to help the infant attach, then maintain a supportive hand position and use breast compression when swallowing slows.
A C-shaped hold can be particularly useful for this because the same hand position can support the breast's shape and apply pressure during feeding. The purpose of the hand movement changes according to what the infant needs at that point in the feed.
The aim is to support comfortable attachment and effective milk transfer, not to make the infant continue feeding when they are showing signs that they have finished.
When these techniques are not enough
Breast shaping and breast compression can be useful tools, but they do not replace an assessment of the whole feeding picture. If an infant is persistently struggling to attach, feeding for long periods without appearing satisfied, having difficulty transferring milk or not gaining weight as expected, further assessment may be needed.
Positioning, attachment, oral function, tongue movement, milk supply and the infant's ability to coordinate sucking, swallowing and breathing may all be relevant. A review of the infant's feeding can help identify whether changes to positioning, additional feeding support or assessment of oral function are appropriate.
You may find these articles helpful:
When to seek feeding support
If you are concerned about your infant's milk intake, weight gain, feeding behaviour or your milk production, seek support from an appropriately qualified infant feeding practitioner or healthcare professional. An assessment can help establish whether the difficulty relates to attachment, milk transfer, infant oral function, milk supply or another factor.
You can read more about the different types of feeding support available in these articles:
References
Daly, S.E.J. and Hartmann, P.E. (1995) ‘Infant demand and milk supply. Part 2: The short-term control of milk synthesis in lactating women’, Journal of Human Lactation, 11(1), pp. 27–37. https://doi.org/10.1177/089033449501100120
Douglas, P. (2022) ‘Re-thinking benign inflammation of the lactating breast: classification, prevention, and management’, Women's Health, 18.
Douglas, P. and Keogh, R. (2017) ‘Gestalt breastfeeding: Helping mothers and infants optimize positional stability and intraoral breast tissue volume for effective, pain-free milk transfer’, Journal of Human Lactation, 33(3), pp. 509–518. https://doi.org/10.1177/0890334417707958
Geddes, D.T., Kent, J.C., Mitoulas, L.R. and Hartmann, P.E. (2008) ‘Tongue movement and intra-oral vacuum in breastfeeding infants’, Early Human Development, 84(7), pp. 471–477. https://doi.org/10.1016/j.earlhumdev.2007.12.008
Geddes, D.T., Langton, D.B., Gollow, I., Jacobs, L.A., Hartmann, P.E. and Simmer, K. (2008) ‘Frenulotomy for breastfeeding infants with ankyloglossia: Effect on milk removal and sucking mechanism as imaged by ultrasound’, Pediatrics, 122(1), pp. e188–e194. https://doi.org/10.1542/peds.2007-2553
Newman, J. (2017) ‘Breast compression’, International Breastfeeding Centre, 23 May 2017. https://ibconline.ca/breastcompression/
Pados, B.F. and Camp, L. (2024) ‘Physiology of human lactation and strategies to support milk supply for breastfeeding’, Nursing for Women's Health, 28(4), pp. 303–314. https://doi.org/10.1016/j.nwh.2024.01.007
Pearson-Glaze, P. (2023) ‘What is breast compression?’, Breastfeeding Support, revised 9 October 2023. https://breastfeeding.support/what-is-breast-compression/
Smyth, C. (2017) ‘Breast shaping – it is ok to hold your breast!’, 22 October 2017. https://www.carolsmyth.co.uk/perinatal-infant/breastfeeding-resources/posts/2017/october/breast-shaping/
Smyth, C. (2020) ‘Baby to breast not breast to baby’, 23 February 2020. https://www.carolsmyth.co.uk/perinatal-infant/breastfeeding-resources/posts/2020/february/baby-to-breast-not-breast-to-baby/
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