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.