Breastfeeding and Abnormalities of the Breast

Breast Pathology and Problems Nursing Women May Face

Breast cancer, conceptual image: Breast Problems and Breast Pathology for Breastfeeding Women
What types of breast problems can arise when you're breastfeeding?. IAN HOOTON / Getty Images

Breast Problems Can Interfere with Successful Breastfeeding 

There are many possible breast problems that breastfeeding mothers may face. Most breast issues are common and are not a cause for concern. But, some breast problems can be a sign of something more dangerous.

It's very important to understand and identify any issues that you run into as soon as possible. By quickly taking care of breast problems when they arise, you can prevent them from developing into more complicated issues that can interfere with breastfeeding your baby and your future health.


Uneven Breasts (Breast Asymmetry)

There are three typical situations when breastfeeding women may have uneven breasts

  • One breast may be slightly larger than the other, but it is not causing any concern. Slightly uneven breasts are normal when you're breastfeeding. It's often the result of your baby's breastfeeding pattern. The breast that you're going to start the next feeding on will be fuller and larger than the breast you used to start the last feeding. 
  • One breast may be dramatically larger than the other, and you may be making much more breast milk on that side. Sometimes a woman develops more milk-making tissue in one breast compared to the other. Or, if you've had breast surgery or breast cancer treatments on one breast, that breast may not make as much breast milk. When one breast doesn't make very much breast milk, but the other one does, the breasts will look uneven. But, as long as your doctor says it's safe, and one breast can make breast milk, you can breastfeed your baby from that one side. It's also very possible to make a healthy supply of breast milk with just one breast. Have your child's doctor monitor his weight and health. If all is well, you can breastfeed exclusively from just one side. 
  • One breast is bigger than the other because your baby has begun to favor one side. Your baby can develop a breast preference for many reasons. When a baby prefers one side over the other, breast milk production can slow down in the breast that the baby doesn't want and cause that breast to appear smaller.  

    Underdeveloped Breasts (Hypoplastic Breasts)

    If you have hypoplastic breasts, you were born with them. It's a breast issue where the glandular (milk-making) tissue in the breast does not fully develop. Underdeveloped breasts may be widely spaced, long, or thin, and you may not know that you have them until you get pregnant and have your baby. 

    If your doctor tells you that you have insufficient glandular tissue in your breasts, you can still breastfeed. However, it can be tough to build your milk supply so you may need to supplement your baby

    Breast Lumps

    Your breastfeeding breasts may feel lumpy, especially when they're really full. It's normal to be nervous when you feel a lump in your breast but try to remember that most lumps that you feel when you're breastfeeding are not serious

    There are three general categories that breast lumps fall into:

    • Benign breast disease: Benign means not harmful. If you have a benign breast lump or lumps, you may feel swelling and tenderness, breast pain, or general lumpiness in your breast.
    • Fibroadenoma: A fibroadenoma is a tumor in the breast tissue that is NOT cancer. It may feel like a single painless mass, but it is solid, firm, rubbery and elastic to the touch. This movable mass can be round, oval, or made up of many lobes, and it is usually between 1 and 5 centimeters in size.
    • Breast Cancer: Only a small percent of breast lumps found in breastfeeding women turn out to be cancer. Breast cancer tends to show up as a painless mass on only one side. It's solid, hard and dense. The borders of the mass are irregular, and it's difficult to move around because it's attached to the surrounding breast tissue. 

    Breast Problems

    Some of the breast problems that can arise during breastfeeding include: 

    Plugged Milk Ducts: Plugged milk ducts are hard, tender, lumps that form in the milk ducts and block the flow of breast milk. Plugs typically clear up in less than a day with frequent breastfeeding or pumping to the remove breast milk from your breasts. 

    Mastitis: Mastitis is inflammation (swelling) of the breast tissue. It causes pain, swelling, and redness in the affected area on the breast. It can also cause flu-like symptoms. You may need to take an antibiotic if there's an infection present, so call your doctor. You can begin to recover from mastitis within 48 hours if you get plenty of rest, take your medication, and breastfeed very often.

    Breast Engorgement: Breast engorgement is one of the most common breastfeeding problems. It's caused by an increase of fluids in the breasts including breast milk, blood, and lymph. Engorgement can be painful and make it difficult for your baby to latch on and nurse. You can treat engorgement by breastfeeding very often, using a breast pump to relieve excessive pressure in breasts, placing cold compresses or cabbage leaves on your breasts for comfort, and taking an over-the-counter pain reliever such as Tylenol or Motrin if necessary. 

    Galactoceles: A galactocele is a cyst filled with milk that's often caused by the blockage of a milk duct. A doctor usually drains the galactocele by removing the milky fluid with a needle

    Breast Abscess: A breast abscess is a rare complication of a breast infection. It's a pocket of fluid that builds up in one area, but there have been cases where women have had two in the same breast. Your doctor may have to remove the fluid with a needle, or you may need a minor surgery. 

    Nipple Blanching: Nipple blanching is due to the sudden disruption of the blood flow to the nipples. The nipples turn white and may burn. Then, as the blood flow returns, the nipples gradually turn back to their original color. Nipple blanching can be very painful. To treat nipple blanching, make sure your baby is latching on well, try to prevent sore, cracked, and damaged nipples, and keep your breasts warm. 

    Signs That Shouldn't Be Ignored

    If you see any of these breast changes, see your doctor for an examination. Early detection of breast problems can lead to successful treatment. 

    • A Dimple In the Breast: A wide, shallow dimple in the breast is a sign of skin retraction. Dimpling can be caused by the shortening of the Cooper's ligaments, which may be a sign of inflammation or breast cancer.
    • Nipple Retraction: The pulling back of the nipple may be either harmless (the majority of retractions) or malignant (occasionally associated with breast cancer). Make sure not to confuse retraction with inverted nipples
    • Fixation: Bend forward and examine your breasts for any unevenness, distortion, or decreased movement. With invasive breast cancer, fibrosis "fixes" the breast to the underlying muscles.
    • A Change In the Direction of the Nipple: If the nipple looks as if it's being pulled in a different direction, it could be a sign of breast cancer.
    • Prominent Venous (vein) Pattern: It's normal for breastfeeding women to have very visible veins on their breasts, especially when the breasts are overfull. However, if the veins are only protruding on one side, it can indicate certain types of breast tumors.

    Abnormal Nipple Discharge

    When you're breastfeeding there's normal nipple discharge:

    Then, there's nipple discharge that might be concerning. Abnormal nipple discharge can look similar to normal nipple discharge. It can include:

    • Bloody Discharge: Bloody discharge can be normal, but it could also be a sign that something is not right. Non-cancerous growths called intraductal papillomas can cause watery, bloody discharge, and some types of breast cancer such as ductal carcinoma can also cause bloody nipple discharge. 
    • Purulent Discharge or Pus: Thick, discolored fluid draining from the nipple could be a sign of an infection or mammary duct ectasia

    It may be difficult to tell the difference between what's normal and what's not. So, if you notice any changes or have any concerns, it's always best to talk to your doctor. Tell your doctor what you've noticed, and she'll examine your breasts. She can also send you for additional testing if it's necessary. Your doctor will help you figure out what's causing your symptoms and put your mind at ease. 

    Skin Conditions That Can Appear on the Breasts

    The skin on your breasts is also susceptible to a variety of problems including: 

    • Eczema, Psoriasis, and Dermatitis: These skin conditions cause red, raised, patches on the skin that can be irritating, itchy, or painful. Although it may not be comfortable for you, these issues are not harmful to your baby so you can continue to breastfeed if you suffer from these conditions. 
    • Poison Ivy, Oak and Sumac: The oils from these plants can cause an itchy, red rash with fluid-filled blisters. You should not breastfeed until you heal from these conditions. 
    • Thrush: Thrush is a yeast infection. If you get thrush, you may see white patches on your skin or your nipple may look red or shiny. Thrush can also appear deep in the breast. You may not have any symptoms on the outside of the breast, but inside you may feel a sharp pain. You can continue to breastfeed if you have thrush, but you should seek immediate treatment for both you and your baby. 
    • Herpes: The herpes virus on the breast can show up as small red bumps, fluid-filled blisters, or sores. You should not breast-feed if you have active herpes lesions on your breasts. Herpes is extremely dangerous for infants. Once your lesions dry up and go away and you get the OK from your doctor, you can breastfeed.

    Taking Care of Your Breasts

    You can recognize any potential breast problems by learning about what's normal for your body and examining your breasts regularly. If you notice anything that doesn't look or feel right to you, talk to your doctor right away. It's always better to get things checked out and have them be nothing than to wait and find out you should have called your doctor sooner. 


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    Updated by Donna Murray

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