Breast Issues During Pregnancy And Breastfeeding

Breast Lump

During pregnancy, the breasts can feel generally lumpy but if a specific lump is felt, the patient should present to her doctor for a breast examination and ultrasound.

Most lumps are likely to be benign such as galactoceles (milk cyst) but an ultrasound +/- biopsy may be necessary to establish this.

Nipple discharge

Up to 20% of pregnant women can have bloody nipple discharge in the second or third trimesters.

Some women may also have bloody nipple discharge just prior to lactation (production of milk). This is more common during the first pregnancy and it is still okay to breastfeed while it is happening.

This is usually physiological due to increased blood supply to the ducts during pregnancy (hypervascularity). It requires no treatment.

However, any new symptom should be discussed with your doctor. If the discharge persists or has any concerning features such as being from a single duct, it should be investigated further with a breast ultrasound.

Mastitis / Abscess

Mastitis is local inflammation of the breast presenting as pain, redness and swelling. It presents most commonly in the first 6 weeks post-partum and is usually associated with other breastfeeding issues such as cracked nipples / engorgement / poor drainage or partial blockage. It can be complicated by bacterial infection and abscess formation (collection of pus).

Mastitis can be avoided by frequent emptying of the breast and optimizing breastfeeding technique.

Treatment of mastitis is usually threefold: antibiotics, emptying of the breast and by treating the underlying problem such as cracked nipples / blocked ducts usually by optimizing breastfeeding technique.

Breast abscesses are usually drained under ultrasound guidance using a local anaesthetic.

If the skin over the abscess is breaking down or too thin, surgical drainage of the abscess under general anaesthetic may be necessary.

For more information on breastfeeding – see the following patient education handouts from Uptodate.com: