Don’t Let a Breast Lump Turn You Into a Grump!

I know, an extra bump in the lady lumps can be annoying! And confusing. Or worrisome. Painful even!

But before jumping to conclusions (and the medicine cabinet), it’s important to first determine what the lump truly is. An abscess? A plugged duct? Something more serious? Your health provider can give you a diagnosis and treatment options, but most of the time lumps found during breastfeeding can be resolved without a trip to the doctor.

Read on to find out more…

Breast Abscess

The condition defined: an abscess is a pocket of pus restricted within the breast tissue, often occurring when a mother stops breastfeeding during an infection like mastitis or if she doesn’t seek mastitis treatment quickly enough. In other words, abscesses tend to occur as a result of poorly managed mastitis.

As opposed to a breast lump, an abscess does not decrease in size after nursing. It’s hot to the touch and painful. Typically, an abscess must be drained by a doctor (needles are preferable to surgical drainage).

If breastfeeding should temporarily cease (some babies don’t like the slight change in milk flavor as sodium and chloride levels rise), the mother should express milk to maintain her supply. Old-school medical professionals often advise a woman to stop nursing until her breast has healed, but this is not necessary.

Up-to-date doctors know that nursing from a breast that is infected or from one with an abscess will not harm the baby. In the past, it was believed that these were indications to stop breastfeeding because the milk would be tainted. Alas, abscesses are pretty rare among women today.

Links:

• “Breast Abscess” – BFeeding Mamma, Tracy Behr
• “Breastfeeding and breast abscess” – a mom’s experience by Rhondda Smiley

Plugged Ducts

Plugs are ‘knots’ in the breast that feel tender and sore. Plugged ducts need to be promptly treated otherwise they can turn into mastitis, a breast infection (if a plug is accompanied by a fever or flu-like symptoms, it has very likely developed into mastitis).

Plugs are more common in women who have engorgement (especially in the first month), oversupply, or those who pump with long periods of time between — all reasons why it’s important to feed frequently and keep the breasts as drained as possible.

An unused, plugged breast is a breeding ground for bacteria, and when the quickly multiplying bacteria gets its chance it will scour the area with infection. Other possible causes of plugged ducts include poor latch (the Super Villain of all breastfeeding problems, right?), tightly fitting bras, and other things that compress the breasts too much like sleeping on your stomach.

Treatments include:

• Nurse, nurse, and repeat! Offer the affected side first. You may find it helpful to hand-express a bit beforehand, and gently massage the knot during the feeding.
• Rest, rest, and repeat! Stay in bed and take a ‘Nursecation,’ if you can.
• Bid adieu to your underwire bras.
• Stop sleeping on your stomach for now.
• Stay hydrated.
• Keep a low-setting heating pad close to the plug when not nursing.
• Try this lecithin treatment.
• Dangle feed.
• Place grated raw cold potato on the affected breast.
• Try these treatments for recurrent plugged ducts.

Be aware that you may notice some string-cheese looking substance coming out while nursing or pumping. This won’t hurt your baby — it’s just the clogged milk finally escaping, so don’t worry (even if you are kind of seriously wondering whether your boob has turned into a spaghetti-maker)!

Is the plugged duct actually a galactocele?

Galactoceles are milk-filled cysts that are typically painless and soft and won’t lead to infection. They usually resolve on their own but can be aspirated or excised.

Breast Lumps

A lump in the breast tissue is not uncommon during the lactation period, especially in the early months. In most cases, this shouldn’t be alarming as 80% of lumps are cysts, scar tissue, abscesses, lipomas (fat-filled cysts), fibroadenomas (harmless tumors made of glandular/fibrous breast tissue) or other benign conditions.

Lumps are not the same as plugged or clogged ducts (when accompanied by fever, this may actually be the breast infection called mastitis).

Did you know that breastfeeding reduces a woman’s risk of getting breast cancer? By 4.3% every year she nurses, in fact! (2002 report, Lancet). Theoretically, this means if she breastfeeds three babies for four years each, her chance of getting breast cancer is decreased by more than HALF.

When is a lump ‘just’ a lump, and when can it signal a more frightening circumstance?

Cancerous lumps are fixed in place, while other types of benign lumps are somewhat more mobile and uniform in shape.

Karen Koch wrote for LLLI:

“Benign lumps usually feel round, smooth and move about in the breast tissue. Cancerous lumps can be irregular in shape, feel ‘gristly,’ and are more likely to be fixed in the breast tissue.”

If a mammogram is performed but found inconclusive, needle aspiration and biopsy may be the next step recommended by a doctor to determine whether the mass is solid or fluid-filled. Those with type 1 diabetes are especially at risk of developing lumps called diabetic mastopathy.

Is it necessary to wean from breastfeeding to get treatment for a lump?

Working breasts may be more challenging to read by mammogram, but that doesn’t mean weaning is necessary (though many practitioners still believe this). You can nurse prior to a mammogram to get a more accurate reading and to feel more comfortable during the procedure. Ultrasound is another option for diagnosis in certain situations; breastfeeding is not affected.

If surgical lump removal is required, Koch explains that:

“[l]actation might make the surgery a bit trickier because milk may leak if ducts are cut, but does not preclude breast surgery. Some surgeons are not comfortable performing surgery on a lactating breast. They might insist that a mother wean her child before surgery so there is no milk present in the ducts. This is not practical because it can take several weeks to months for all milk to disappear completely and if a breast lump is suspicious the mother will not want to wait.”

Nursing can resume as soon as the mother feels up to it post-surgery.

Can breastfeeding continue if the lump is found to be cancerous or at-risk?

If a woman receives chemotherapy for a mass determined to be cancerous, she must wean before starting treatments. It is sometimes possible to continue breastfeeding on the unaffected side if only undergoing radiation treatment, however. Successful lumpectomy should allow a mother to resume breastfeeding. Mastectomy obviously renders breastfeeding impossible on the operated side.

Links:

• “Breastfeeding and Breast Cancer” – Barbara Wilson-Clay, BS, IBCLC
• “Breast Health and Breastfeeding” – Kathy Koch, MEd, IBCLC