Breast Problems During Pregnancy and Lactation: Frequently Asked Questions

Carol Scott-Conner, M.D.
Department of Surgery
University of Iowa Hospitals and Clinics
Creation Date: April 2000
Last Revision Date: April 2000
Peer Review Status: Internally Peer Reviewed

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Most of the common problems that occur during pregnancy, or lactation, can be managed without interrupting either the pregnancy or the breast-feeding. A woman who develops a lump in her breasts should see her physician because occasionally it is a sign of something more serious.
What are the most common problems a woman faces with her first child and breast-feeding? How can an expecting mom prepare herself for these issues?
The most common problem is nipple irritation and associated with that is mastitis, or inflammation and infection in the breast. The best way to prepare for this is by seeking the guidance of someone who is experienced in breast-feeding. There are now lactation consultants in many communities, and they are excellent sources of information. The nipples are a very sensitive area, and when the new baby starts to nurse, irritation may occur. Careful hygiene and cleanliness are important.
How can a woman prevent "cracking nipples" during lactation?
The best way to prevent cracking nipples is to use an approved lubricant of some kind. Check with your physician or health care provider for something to put on the nipples to keep them from drying out.
What advice would you give someone who developed a significant galactocele during her first lactation? Do I need surgery to correct it?
It may or may not re-accumulate during the 2nd pregnancy and lactation. I would not advise prophylactic surgery. Galactocele's are generally treated by aspiration and if this one recurs, then you should see your physician.
I am not sure if I am in right room, my son is almost 2. I never breastfed him, but I continued to leak until he was 8 mo. Now 2 years later I am leaking again, any ideas?
You should see your physician. That could be something serious.
What is galactocele, and is it preventable?
Galactoceles are single or multiple nodules that contain milk. Anything that obstructs the duct of the breast during lactation may cause a galactocele. Most often, galactoceles occur at the end of breast-feeding when the milk is allowed to stagnate in the breast. Sometimes the mass isn't found until months later. There really aren't any preventive measures, and galactoceles are simply dealt with by aspirating the milk with a needle.
Unfortunately, my OBs had trouble diagnosing the galactocele and it achieved about 8 centimeters in diameter. Would you consider surgery prophylactic at that point?
Again, we don't generally advise prophylactic surgery for galactoceles. If a large galactocele has been a problem in the past, then early detection and aspiration, if it recurs, should solve the problem.
Is there any reason a mother should consider not breastfeeding?
That is an individual decision that a woman should take up with her obstetrician but I am not aware of any specific conditions, with the exception of some very rare illnesses, that would make it wrong for a woman to breast feed. Some medications that a woman might have to take for life-threatening illnesses are excreted in the breast milk and that could be a problem. A woman should talk this over with her obstetrician. Remember, there are numerous benefits to mother and child from breast-feeding. Also, studies show that breast feeding reduces the risk of getting breast cancer later in life.
Can women continue to nurse, even when experiencing problems such as galactoceles?
Yes, a woman can continue to nurse and sometimes keeping the breasts empty by nursing helps the problem go away. Occasional repeated aspiration is needed. If the galactocele keeps coming back, surgery may be required.
Are lactation consultants a good idea?
I think that if it is your first baby, getting advice from someone who knows how to teach you the ins and outs of breast feeding is very important. For many women, a lactation consultant is the best option. Depending upon your circumstances, you may find that a nurse, a nurse midwife, or your obstetrician may be able to offer similar advice. Of course, some women get the support from other women in their family. The La Leche League is a nationwide organization that helps women with breastfeeding.
During lactation, one of my breasts grew quite larger than the other (obviously my son preferred that one because it seemed to produced more milk!) Is there any way to prevent this from happening with my next child?
I don't know of any way to prevent this. It is normal for the breast to increase during size and weight during pregnancy. Usually the increase is symmetric but occasionally one breast enlarges more than the other. It is likely that if this has happened once, it may happen again.
How do you manage breast infections? Do you have to stop breast-feeding?
Breast infections don't have to interrupt breast-feeding. Antibiotics can treat most of the common breast infections, and the woman can continue to breast-feed. Keeping the breasts empty by the baby nursing actually helps by avoiding the accumulation of milk in the breast because milk is a culture medium and the bacteria can grow in the milk. It does not have to interrupt breast-feeding.
What happens if a woman is diagnosed with breast cancer during pregnancy?
We can treat breast cancer during pregnancy without interrupting the pregnancy. Fortunately breast cancer is rare during pregnancy, but it occasionally occurs. Women that have breast cancer have had children come to term and do well. There isn't any danger of transmitting the cancer to the unborn child. We have enough alternatives in treatment now that we can treat the cancer adequately.
I've heard that bloody nipple discharge can be a sign of cancer. What about bloody nipple discharge during pregnancy?
During the last part of pregnancy, that is the last trimester, the nipple undergoes changes preparing for breast-feeding. With these changes, it is fairly common for women to have nipple discharge that may even be bloody. It usually gets better once a woman starts breast-feeding. It is not necessarily a sign of cancer. We don't do anything other than watch and carefully examine the woman.
What are the most common reasons women give up on breast-feeding?
Sometimes women think they don't produce enough milk, and they become discouraged and give up. I think it would be better to supplement with formula if necessary and continue breast-feeding as long as possible. That has probably been the most common reason I have seen women give up.
What should a pregnant woman do if she finds a lump on her breast?
A pregnant woman who finds a lump in her breast should see her physician for a careful examination, an ultrasound of the breast, and possibly an aspiration. Most breast lumps that occur during pregnancy are benign but occasionally women do develop breast cancer during pregnancy. Any lump that develops should be taken seriously whether the woman is pregnant or not. We don't do mammograms in pregnant women because the breasts are so dense from the pregnancy that mammograms are not very effective. Ultrasound is an excellent way to study various masses and is very useful. A woman who develops a lump in her breast during pregnancy should have it evaluated.
When should you stop breast-feeding?
That is something that ought be worked out with your own physician.
Do you need to do anything after you stop breastfeeding to stop the milk production?
Generally, just stopping breast-feeding suppress lactation. In addition, there are medications that a physician can prescribe.
What are some of the more common breast problems experienced during pregnancy? Are they hereditary? What types of breast problems occur in women who are NOT pregnant?
Breast lumps are very common in women who are pregnant and women who are not pregnant. Most of the time, these are caused by benign problems that are not cancerous. Once in a while, a lump is a sign of something serious. For that reason, any women, pregnant or not, who finds a lump in her breast should see her physician and have it checked out. Nipple discharge, as discussed earlier, is also a fairly common sign and in pregnant woman is also less worrisome but again should be evaluated by a physician. Breast pain is a very common and nonspecific problem in both pregnant and non-pregnant women. During pregnancy, the breasts enlarge; they get heavier and the blood supply increases. This makes it harder to feel lumps and makes it very important that a woman have a good breast exam early in pregnancy as a baseline for later comparison. Most of the common problems are not hereditary.
How do you fix an inverted nipple?
We usually leave inverted nipples alone and most women with inverted nipples are able to breast feed. If the nipple inversion is new, that is if the woman has not had it all of her adult life, it may be a sign of a problem and she should see her physician.
Do fibrocystic breast become more "lumpy" after pregnancy?
After pregnancy and after breast feeding, once you are finished breast feeding and they have shrunk down again, or involuted, lumps may be more prominent which creates the appearance of being more lumpy.