Benign Breast Changes Associated With Pregnancy and Breastfeeding

Even though most changes in the breast during and after pregnancy are benign, a word of caution: breast cancer can and does happen in pregnant women and new mothers. Any unusual symptoms, such as a lump or irritated area, should be reported to your doctor right away. It’s always best to err on the side of caution and get it checked.

If you have a breast mass, your doctor likely will examine the breast and order an imaging study (or studies). Mammography with an abdominal shield (a special shield to protect the fetus from exposure to the X-rays) is considered safe. However, ultrasound — which uses sound waves rather than X-rays — is usually the test of choice. It can help your doctor tell the difference between a cyst, which is filled with fluid, and a growth that has some solid parts. A cyst might have to be aspirated (drained with a fine needle), and a solid mass might require core needle biopsy to rule out cancer.

During breastfeeding, an even more common problem is infection, which can cause pain, redness, and inflammation. Breast infections can be pretty persistent, but most respond to treatment with antibiotics. If your symptoms don’t improve, your doctor should rule out any possibility of inflammatory breast cancer. This is an aggressive but rare form of breast cancer that first appears as an area of redness and skin irritation, rather than a distinct lump. Your doctor may need to order a skin or tissue biopsy to be sure.

For most women, changes in the breast during pregnancy and breastfeeding turn out to be benign. Any of the benign conditions already discussed in this section can appear in a pregnant woman. The following are benign conditions specifically associated with pregnancy and breastfeeding. None is associated with an increased risk of developing breast cancer.

Lactating adenoma

Lactating adenoma is the most common cause of a breast mass in a pregnant or breastfeeding woman. An adenoma is a tumor made up of mostly glandular tissue. It can be brought on by the hormones associated with pregnancy and breastfeeding. You may have one lactating adenoma or many. The growths are freely movable, they have clear borders, and they typically contain multiple lobules (lobulated).

Galactoceles

Galactoceles are milk-filled cysts thought to result from the blockage of a duct during breastfeeding. The first symptom is usually a tender mass in the breast. Ultrasound can confirm that it is indeed a cyst. In some cases a galactocele may be drained to relieve symptoms. Cool compresses or ice packs and a comfortable, supportive bra can help. If a galactocele comes back, it can be drained again. In a small number of cases, it can lead to infection that requires treatment with antibiotics.

Bloody nipple discharge

During pregnancy or breastfeeding, many women experience bloody nipple discharge. This may be due to trauma or some underlying issue that may need to be evaluated. Your doctor may take a sample of the discharge for analysis under a microscope, noting which duct is involved. Usually nothing abnormal is found, and your doctor can continue monitoring you during follow-up appointments. If there are abnormal cells in the sample and/or there is a mass in the breast, further imaging and biopsy might be needed. You and your doctor can work together to decide what’s best in your situation.

Lactational infection (mastitis)

During breastfeeding, it’s not unusual for the nipples to become sore and develop small cracks, especially when you’re just getting started. Bacteria can multiply on the breast and enter the body through the nipple, causing an infection known as mastitis. As the body tries to fight the infection, the breast can become red, inflamed, and tender. Other symptoms may include:

• fever, headache, generally feeling ill
• a lump in the area
• thick, whitish nipple discharge
• an abscess, or the collection of pus in the area

Mastitis is treated with antibiotics. It should get better within about 10 days or 2 to 3 weeks at the most. For pain relief, over-the-counter pain relievers such as acetaminophen (brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin) can be helpful, along with warm compresses applied every few hours. If an abscess forms, it may need to be drained using a needle or during a minor surgical procedure.

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Mastalgia (Breast Pain)

Mastalgia, more commonly known as breast pain, affects many women at some point in their lives. Many women fear that pain and tenderness are early signs of breast cancer, but usually that’s not the case. You and your doctor can work together to rule out breast cancer as a possible cause — especially if you have other symptoms such as a mass, growth, or area of thickened tissue in the breast, nipple discharge, and/or inflammation.

If your pain feels focused in one area of the breast, it can be worth checking that with ultrasound. But pain is more likely the result of an underlying benign condition such as fibrocystic breast changes or a single cyst or fibroadenoma. Often a definite underlying cause can’t be found.

Generally, mastalgia can be classified as either:

• Cyclic breast pain: Cyclic mastalgia affects women in their 20s, 30s, or 40s, while they are still menstruating. This pain occurs toward the end of the menstrual cycle in the week or so before you get your period. The breasts are often painful, tender, and swollen at this time, but symptoms improve at other points in the cycle. The pain usually affects the outer and upper parts of both breasts, and it might involve your underarm area as well. Most cases of mastalgia are cyclic.
• Noncyclic breast pain: This type of pain doesn’t bear any relation to the patterns of your menstrual cycle. It often feels like a sharpness, burning, or soreness in one area (or areas) of the breast instead of a generalized feeling of pain and tenderness. This type of mastalgia is more common after menopause. The pain may be constant or it can come and go. A common cause is costochondritis, or inflammation of the junction of the bone and the cartilage portion of the rib cage, which can be treated with anti-inflammatory medication like ibuprofen (brand names: Advil, Motrin).

Tell your doctor about your symptoms, whether they worsen or improve at different times of the month, and how they affect your quality of life. You can keep a daily pain journal to record when you’re having pain and how severe it is. Tell your doctor about any medications that you use. Birth control pills, infertility medications, and hormone replacement therapies can cause breast pain, as can certain antidepressants.

Some strategies your doctor might recommend include:

• Reduce consumption of caffeine.
• Reduce fat in the diet to less than 15 percent of total calories (this may require the help of a nutritionist).
• Wear a comfortable, supportive sports bra.
• Use a topical pain-relieving gel (nonsteroidal analgesic) such as diclofenac (brand name: Voltaren).
• Take oral pain medicines such as acetaminophen (brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin).
• Apply warm or cool compresses when the breasts are painful.
• Take a multivitamin with vitamin E.
• Try evening primrose oil.

Medications to treat the condition are under investigation. For most women, mastalgia is mild-to-moderate rather than severe and often gets better on its own without treatment.

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Galactorrhea

Galactorrhea is milky breast discharge that happens in women who aren’t pregnant or breastfeeding. It affects as many as 1 out of every 4 or 5 women. It can happen at any age, even after menopause, and even if you’ve never had children. Often it’s caused by excess levels of prolactin, the hormone that triggers milk production. Prolactin is produced by the pituitary gland, a small gland at the base of your brain. You may find that your menstrual periods stop or become less frequent while you have the milky discharge.

There can be a number of underlying factors at work, such as:

• excessive stimulation of the breasts either as part of sexual activity, during frequent breast self-exams, or due to certain articles of clothing (such as rubbing against a sports bra during high-impact exercise)
• use of certain medications, including antidepressants, sedatives, antipsychotics, or high blood pressure drugs
• use of certain herbal supplements, such as fennel or anise
• an underactive thyroid gland
• disorders affecting the pituitary gland, such as a noncancerous tumor
• birth control pills

Your doctor will work with you to figure out what may be causing the milky discharge. In addition to taking your medical history and examining your breasts, your doctor may order tests such as:

• analysis of the nipple discharge
• a blood test to measure levels of prolactin and possibly of thyroid-stimulating hormone (if a thyroid problem is suspected)
• imaging tests such as mammogram and/or ultrasound, to examine the breast tissue
• an MRI (magnetic resonance imaging) study to check your pituitary gland

Your treatment depends on the underlying cause of the discharge. Stopping certain medications or herbal supplements often improves symptoms. If you have an underactive thyroid gland, you can take medication to boost low hormone levels (thyroid replacement therapy). For a pituitary tumor, your doctor may prescribe medication to shrink it or recommend surgical removal.

A medication called cabergoline (brand names: Dostinex, Cabaser) can also be used to lower prolactin levels. Another option is bromocriptine (brand names: Cycloset, Parlodel), but significant side effects are more common with this medication.

In many cases of galactorrhea, no definite cause can be identified and the condition simply goes away on its own. A comfortable bra and nipple pads (like those used by women while breastfeeding) can be helpful in the meantime.

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Skin-associated Infection (Cellulitis)

Cellulitis is an infection of the skin and underlying tissue caused by bacteria. This condition usually affects the lower half of the breast where sweat and bacteria tend to build up. The skin becomes red, warm, and inflamed, and the rash tends to spread throughout the area. You also can develop flu-like symptoms such as a fever and chills. Risk factors include being overweight, having large breasts, and/or having previous breast surgery or radiation therapy.

Cellulitis is a fast-spreading infection that requires prompt treatment with antibiotics. If an abscess (collection of pus) forms, it has to be aspirated with a needle or drained through a local incision.

Strategies for preventing cellulitis of the breast include:

• keeping the area as clean and dry as possible
• washing and thoroughly drying the area twice a day
• avoiding cream, lotions, and talcum powders in the area
• wearing a cotton bra or vest or a cotton T-shirt under the bra

Women with large breasts who have recurrent cellulitis may find relief by having breast reduction surgery.

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Subareolar/Periareolar Infection

Subareolar and periareolar infections can occur under or around the nipple and areola due to a blockage forming in one or more ducts. These infections are directly linked to smoking, and it’s hard to get them to heal until a woman stops smoking.

The infection can present as:

• inflammation of the area, with or without a mass
• an abscess (collection of pus)
• subtle retraction (pulling inward) of the nipple
• a mammary duct fistula, which is an abnormal passage that joins the skin in the areolar region directly to a duct under the nipple (recurrent abscesses often occur before a fistula forms)

These infections are treated with antibiotics. If there is an abscess, it may need to be aspirated (drained with a needle) or your doctor may need to numb the breast and make a small incision to drain it. If the infection recurs repeatedly, your doctor may decide to remove all of the affected ducts.

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Mastitis

Mastitis is a condition in which the breast becomes inflamed due to an underlying infection. Although mastitis usually affects women during breastfeeding, it can happen at other times, too. Bacteria can enter the breast duct through the nipple or a skin break and lead to infection. As the body fights the infection, the breast can become red, inflamed, and tender.

Other symptoms may include:

• fever, headache, generally feeling ill
• a lump in the area
• thick, whitish nipple discharge
• an abscess, or the collection of pus in the area

Mastitis is treated with antibiotics. It should get better within about 10 days or 2 to 3 weeks at the most. Over-the-counter pain relievers such as acetaminophen (brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin) can be helpful, along with warm compresses applied every few hours. If an abscess forms, it may need to be drained using a needle or during a minor surgical procedure.

Although mastitis can be quite painful, it doesn’t increase your risk of breast cancer.

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Fat Necrosis and Oil Cysts

Fat necrosis and oil cysts are two different conditions that result from the same process: damage to fatty tissue inside the breast. This can happen as a result of an injury to the breast or treatments such as surgery and radiation therapy.

Fat necrosis develops when the body replaces damaged cells with firm scar tissue. Both during clinical breast exams and on a mammogram, it’s often impossible to tell the difference between fat necrosis and breast cancer. So biopsy is needed for diagnosis.

With oil cysts, the fat cells don’t turn into scar tissue but instead die and release their contents. This causes fluid-filled sacs to form within the breast. Oil cysts are usually diagnosed with fine needle aspiration.

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