Because of technical limitations, an impact of machine milking on the teat tissue cannot be avoided. The continuance of this impact during and after milking depends on a variety of factors related to the physiological regulation of milk ejection, as well as the different production systems and milking machine settings. Milking machine settings aim to achieve a high milking performance, that is, short machine-on time at a maximum of milk harvest. However, a high milking performance level is often related to an impact on the teat tissue caused by vacuum or liner compression that can lead to pathological dimensions of congestion of the tissue or hyperkeratosis as a long-term effect. Toward the end of milking a decrease of milk flow rate causes a raise of mouthpiece and teat end vacuum levels and hence an increase of the impact on the teat tissue and the risk of tissue damage. The mechanical stress by the milking machine activates a cascade of cellular mechanisms that lead to an excessive keratin growth and thickening of the keratin layer. Consequently, a complete closure of the teat canal is disabled and the risk of bacterial invasion and intramammary infection increases. Another consequence of high vacuum impact is fluid accumulation and congestion in the tissue of teat tip and teat basis because of an obstruction in venous return. The present review paper provides an overview of the available scientific information to describe the interaction between different levels and types of system vacuum, mouthpiece chamber vacuum, teat end (claw) vacuum, liner pressure, and the risk of short-term and long-term impacts on the teat tissue.