It is very common to develop breast masses or breast lumps during breastfeeding. The majority of these are benign meaning they are not cancerous. But it is natural for women to be concerned about any suspicious breast lump during breastfeeding or any other abnormality within the breast.
Many times mothers wonder whether the breast lump developed during breastfeeding is breast cancer!
Although this occurs rarely, it can happen.
This article discusses in detail the various causes of breast lumps during breastfeeding, the various modalities available to diagnose them and the treatment options available.
Pregnancy and lactation is a period of hormonal upheaval for a woman’s body. During this period, the breasts undergo several physiological changes. These changes occur due to various hormones that cause hyperplasia of the breast tissue for the preparation of breast milk secretion.
Read more about Breast Milk Production and Regulation
Common Causes of Breast Lumps During Breastfeeding
In the initial days of breastfeeding, when the breasts start producing a larger quantity of milk, they may become hard, lumpy and painful. This is called engorgement.
The condition occurs most commonly during the first few days of childbirth but can also occur if the breasts are not drained completely.
This is a normal phenomenon that occurs due to the increased production of breast milk. It is also temporary in most of the cases and resolves on its own within a few days if the mother continues to breastfeed her child at frequent intervals. However, if it fails to resolve, milk may have to be drained using a breast pump or anti-inflammatory medication may be required.
Read more about Breast Pump: Types, Working, Uses, and Selection Tips
It is another common cause of breast lumps found during breastfeeding.
Milk is produced by the breast cells from where through the ducts, it travels to the nipple. If the milk is not drained from the breast completely and frequently, it can lead to trapping of the milk within the breast as well as blockage of the duct.
It usually presents as a painful lump within the breast.
Treatment involves emptying of the breast frequently either by regular breastfeeding or by pumping. Gentle breast massage, and applying warm compresses also help to resolve a blocked duct.
Mastitis means inflammation of the breast tissue.
Accumulation and blockage of the milk within the breast tissue or ducts may get infected leading to mastitis. Besides the presence of a painful lump, the mother may present with fever, chills and rigors, and redness of the involved skin of the breast.
Treatment involves antibiotics and anti-inflammatory medication. The mother should continue breastfeeding since it prevents the build-up of milk and helps to drain the breasts.
If engorgement or mastitis is not treated, it may lead to a build-up of infection resulting in the formation of an abscess. An abscess is a cyst filled with pus and bacteria.
The presence of an abscess should not be ignored. The mother needs to consult her health care professional. In most of the cases, the abscess needs to be drained along with the administration of antibiotics.
These are harmless breast cysts that contain milk. They occur due to the accumulation of milky fluid within the breast. The lump feels like a smooth, round, moveable sac inside the breast. They are usually small and painless.
Most of the cases don’t require any treatment as they tend to resolve on their own with time. However, if they are large in size, are causing discomfort or get infected, they need to be drained.
They are benign breast tumors (not cancerous). They are firm and move freely within the breast.
Fibroadenoma may be pre-existing prior to pregnancy or lactation. It increases in size during pregnancy because of its sensitivity to hormone levels. Those which are smaller in size may be left as such. Larger ones may be observed or excised. In any case, their treatment is not an emergency and can be delayed until the child is breastfeeding.
It is a lumpy painful condition of the breast which occurs most commonly during the childbearing age of the mother. A normal hormonal variation that occurs during the menstrual cycle is the main cause of fibrocystic breast disease.
The lumps due to this disease are usually present prior to pregnancy or breastfeeding. If the condition becomes intensely painful, anti-inflammatory medication, primrose oil or warm compresses may be given to the mother.
It is also a benign tumor of the breast. It occurs in association with pregnancy and is usually seen during the last months of pregnancy and period of lactation.
It is a firm, mobile and non-painful mass.
No treatment is generally required as it resolves spontaneously once the mother stops breastfeeding her baby. Larger tumors may need excision.
Other benign tumors
Lipomas, hamartomas or other benign tumors may occur during breastfeeding or may be present before pregnancy or start of lactation. Once their benign nature is confirmed, no further treatment is required until the mother is breastfeeding. Once the mother stops feeding, the lump may be excised.
While it is possible to develop breast cancer while breastfeeding, it is rare. Breastfeeding mothers constitute 3 % of all breast cancer cases.
Breastfeeding is known to have a protective effect against several diseases including cancers. Pregnancy and breast-feeding decrease the number of menstrual cycles that a woman experiences in her lifetime, thereby reducing her exposure to hormones. Exposure to certain hormones like estrogen is known to increase the risk of certain cancers. In spite of this, breast cancer can occur in women who have in the past or are currently breastfeeding their babies.
In spite of the low risk, any breast lump discovered during pregnancy should be taken seriously and properly investigated.
How to Diagnose Breast Lump During Breastfeeding
It is the first and most important step for the diagnosis. A health care professional will examine the swelling and based on the characteristics of the lump will advise which investigations are required.
- A red hot painful swelling is most likely due to blocked duct or mastitis or breast abscess.
- A lump that is freely mobile within the breast is likely to be a fibroadenoma.
- Benign tumors will be soft or firm in consistency and will not be fixed to skin or underlying structures.
- Breast cancer is usually hard in consistency, painless and fixed to the underlying structures or overlying skin. It may cause the skin to dimple or to resemble an orange peel
Ultrasound uses high-frequency sound waves to view the breast tissue. It is usually the first investigation to be carried out for any breast lump. It is non-invasive and free of harmful radiation.
It is absolutely safe to be used in lactation.
It can distinguish between fluid-filled (cystic) and solid breast lumps. It is better to empty the breasts before ultrasound so as to improve the quality of the images.
It is the most effective non-invasive test to detect breast cancer. However, during pregnancy and lactation, ultrasound is considered superior to mammography because the hormone-induced changes in breast tissue which result in increased density of breast tissue make interpretation difficult. To improve the quality of images and making interpretation easier and reliable, it is advised that the breasts should be empty of milk as much as possible. This can be done manually or with the help of a breast pump.
In this procedure, a fine needle is inserted into the lump and some material is aspirated. This material is then spread on a glass slide, stained with appropriate stains and examined under a microscope. In most of the cases, this investigation is able to categorize the condition as infectious, benign or cancerous. It is also a quick, relatively painless, non-invasive, outdoor procedure. The results are available within a few hours and can help to relieve the patient’s anxiety quickly.
Sometimes, when the results are inconclusive on FNAC, a biopsy may have to be performed to be sure that the lump is not cancerous. It is a small surgical procedure carried out under local anesthesia. A small piece of the breast lump is removed (and after a series of steps including processing, fixation, and staining) it is examined under a microscope. It is the best method to confirm whether cancer is present or not. However, the processing and other steps involved make it a lengthy procedure. The results are available in about 3-4 days.
A biopsy can be a core biopsy in which only a tiny amount of breast tissue is removed or it can be excision biopsy (lumpectomy) in which the entire lump is removed.
Self Care Tips for Breast Lumps During Breastfeeding
The presence of a breast lump is not an indication for stopping breastfeeding. In fact for some of the common causes of breast lump found during lactation (like engorgement and blocked ducts), continuing breastfeeding actually helps to relieve the condition. Unless told by your doctor, you should not stop breastfeeding.
Gently massage the lump
Gentle massage of the lump or the entire breast in a downward motion from the chest wall till the nipple helps to soften the lump so that milk can come out easily.
Drain the breasts at regular intervals.
Conditions like engorgement can be effectively treated by feeding the baby frequently so as to empty the breasts. You can also use a breast pump to drain your breasts completely. Gently massage the breasts during feeding so that milk comes out easily.
Wear a properly fitting bra
This helps by giving adequate support to the breasts. A tight bra can put excessive pressure on delicate breast tissue and lead to mastitis.
Ensure proper latching of the baby to the breast
Make sure that the baby is latching on the breast in a correct manner. Proper latching ensures that the baby is efficiently removing the milk from the breasts. This will help to prevent as well as treat lumpy engorgement or painful blocked ducts.
Try different positions while breastfeeding
This allows drainage of different areas of the breast. Many times mothers stop breastfeeding from the breast which has the lump or is engorged. This is absolutely unnecessary and may aggravate engorgement or blocked ducts.
Provide warmth to painful breast
Take a warm shower or apply a warm wet sterile piece of cloth on to the painful breast lump. This will help to relieve pain and soften the lump.
Keep your breasts and nipples clean
Wash your breasts and nipples with lukewarm water to remove any dried milk or debris present on the nipples which may be blocking the flow of milk out of your breasts.
Regular monitoring of the lump size
A lump that gets smaller in size with time or by following the above self-care tips or goes away completely is not a cause of worry.
If however, the lump does not decrease in size or rather appears to grow in size even after a week of first noticing it, then you need to consult your doctor.
When To Consult a Doctor
- The lump does not decrease in size even after 1 week of first noticing it.
- The lump appears to be increasing in size.
- There is intense pain in the breast.
- The skin over the lump becomes red and hot.
- There is fever along with the feeling of being unwell.
- The lump is hard, does not move freely within the breast, causes the skin to dimple or resembles an orange peel.
If the skin overlying the lump becomes red and hot or you develop a fever, consult your doctor or health care professional to check for breast infection.
In the case of mastitis, you will need to take antibiotics and anti-inflammatory medication.
Breast abscess should be drained to remove pus and debris, followed by antibiotic administration.
A galactocele can be left as such to allow it to resolve on its own. If causing discomfort or infected, it may be drained.
In case of benign diagnosis like fibroadenoma, lactating adenoma, lipoma, etc, the mother should continue to breastfeed her baby. Once the baby stops breastfeeding the lump may be excised or observed with long term follow up.
In the case of the rare and unfortunate cancer diagnosis, the mother needs to be treated on priority. Treatment modalities include surgical removal of one or both the breasts, chemotherapy or radiotherapy. In any case, the mother will have to stop breastfeeding.