Breastfeeding Help and Information
Celebrating World Breastfeeding Awareness Week by addressing breastfeeding and breast cancer common questions and concerns.
As many of us know, our bodies can go through some pretty incredible changes; especially our breasts. One miraculous change our breasts go through is the, “pregnancy-breastfeeding-post breastfeeding” phase. With these extreme and sudden changes that our breasts go through it can be hard to know what your “normal” is as you go through this phase. With the help of our certified breast health educators (Lemonistas) who are also certified lactation consultants, we have gathered and answered some of the most common questions and concerns when it comes to breastfeeding and breast cancer. If you don’t see your question answered here, please feel free to reach out through our social media channels and we will have our Lemonistas/lactation consultants on hand to help!
How will my breasts change pre & post breastfeeding?
Breastfeeding is associated with a reduced risk of breast cancer, and the longer women breastfeed, the more the risk decreases. But breastfeeding is just one factor among many that influence breast cancer risk. So although breast cancer is extremely rare while lactating, it can occur, so breastfeeding women should do regular self-exams. Breasts undergo a lot of changes during pregnancy and breastfeeding so understanding these changes helps to know what is normal when doing self-exams. Most of the breast changes when breastfeeding occur during pregnancy due to hormonal changes which prepare the body for breastfeeding. Let’s explore some of these changes.
Breast changes during pregnancy
Breast size increases as glandular tissue, the milk making cells, and the milk duct system develop
Nipples can become more prominent and erect
The areola, the area surrounding the nipple, darkens
The montgomery glands, which are small bumps on the areola, enlarge
Breasts may start to feel tender and sore
The veins on the surface of breasts may become more noticeable
Breasts start to produce milk during pregnancy, this first milk called colostrum, can leak or be expressed
Breast changes while breastfeeding
Breasts become fuller and firmer when breast milk supply increases around days 3 to 5. This is sometimes known as 'milk coming in'
Breasts may feel more lumpy, especially during the first few weeks of breastfeeding
Breast engorgement: this can happen if the breast becomes overfull of milk. Breasts can feel hard, warm and throbbing. Breast engorgement is common in the first week of breastfeeding.
When breastfeeding, most lumps are either milk-filled glands or inflammation. If the lump is tender, it is likely to be a blocked duct or mastitis. If the lump does not go away after a week of careful treatment for a blocked duct or mastitis, then it needs to be followed up with a GP or appropriate Health Care Professional.
Mammograms and Breastfeeding
It should never be assumed that any persistent changes or abnormalities are due to breastfeeding without further investigation. Any changes in breasts should be investigated with the same level of concern, whether breastfeeding or not. Most lumps aren’t cancer, but it’s so important to get them checked out. If a mammogram or ultrasound is needed while breastfeeding, they can be performed on lactating breasts. It’s recommended to pump or breastfeed just before an ultrasound or mammogram. Ultrasounds or mammograms are more difficult to read when you’re breastfeeding, because the breast tissue can be so dense, particularly in the early months of breastfeeding. Breasts are denser when breastfeeding due to the increased glandular tissue necessary for milk production. Because of this, it's important to ensure that the radiologist is experienced in reading images of lactating breasts.
Self Exams and Breastfeeding
Understanding these breast changes help distinguish between pregnancy, lactation related changes, and potential signs of concern. This empowers women to seek timely medical attention when needed. It’s really important for everyone to know what is normal for them by doing regular checks once a month. Using the Know Your Lemons® app makes it easy to do a self-exam every month.
When lactating, it is a good idea to do the self exam after feeding or expressing when the breast isn’t too full. Keep a cloth or muslin handy for any leakage! If anything different or unusual is felt, another check should be done after the baby’s next feed or after pumping.
Knowing your lemons when breastfeeding means breastfeeding parents are informed and proactive and this can be instrumental in early detection of any potential issues.
Breastfeeding parents should never hesitate to seek medical attention if they notice anything different or unusual during self-exams. With the Know Your Lemons® app breastfeeding parents can take charge of their breast health throughout their breastfeeding journey and beyond.
Information provided by: Claire Withey
BIO: Claire is an International Board Certified Lactation Consultant and Know Your Lemons® Educator from Ireland. She lives in Galway in the West of Ireland with her husband and three children. Claire trained with Know Your Lemons after her friend's experience of having breast cancer misdiagnosed while breastfeeding. Claire is passionate about empowering breastfeeding parents with information about breast health and early detection.
What does a lump mean while breastfeeding?
A Blocked Duct
A blocked duct is a blockage of milk caused by swelling compressing the milk ducts inside your breasts. It can be tender to touch and red looking on fair skin. Mastitis is a more severe blockage with a larger area of swelling and can sometimes lead to flu like symptoms and fever.
Remedy for blocked ducts:
cold compresses
ibuprofen
gentle lymphatic drainage massage along with baby continuing to feed or pumping as usual.
If the flu like symptoms and swelling do not begin to improve over 12-24 hours, consult your doctor, as antibiotics may be necessary to treat.
Any sort of lump that does not resolve within a week or so should be assessed by a doctor. They will often refer you to a breast clinic to get it checked out. It is most commonly a milk filled cyst called a galactocele and very rarely anything more.
It is really important to get know your breasts when they are lactating, just as we do when we are examining them when not breastfeeding. Then we can keep an eye on any changes.
Information provided by: Kathryn Stagg
BIO: Kathryn Stagg is an International Board Certified Lactation Consultant, she has recently completed her 5 year recertification. She is a mum to four boys, twins and two singletons and lives and works in Harrow, North West London. She is the founder and trustee of Breastfeeding Twins and Triplets UK Facebook group and charity, and recently published a book called Breastfeeding Twins and Triplets. She became a certified Lemonista a couple of years ago because she says, “as Lactation Consultants, it is incredibly important for us to understands the signs of breast cancer amongst the other normal lumps and bumps common during a lactation journey.”
Contact: Instagram, Website, Twins Website
What nipple changes should I expect while breastfeeding?
Nipple Tenderness and Swelling
Nipple tenderness can be common whether it is your first time breastfeeding or if you have been breastfeeding comfortably for some time. As you breastfeed your nipples naturally elongate but should return to normal quickly. Hormonal causes, such as the menstrual cycle returning, or pregnancy or your little one teething are some causes to nipple tenderness.
Remedies for nipple tenderness and swelling:
Work on adjusting your baby’s latch. However, if the pain is persisting, and leading to nipple damage, seek the support of a trained breastfeeding professional.
Rub a little breast milk into your nipples after feeding to soothe them.
Reverse pressure softening is a simple and highly effective technique to reduce swelling around the nipples.
Bleeding/Cracked Nipples
Cracked and bleeding nipples are not a normal part of breastfeeding. In most cases, it means that the baby’s latch needs adjusting, so please get help as soon as you can from a qualified breastfeeding supporter.
Remedies for bleeding/cracked nipples:
moist wound healing. This means using a nipple cream after feeding and keeping the nipple moist to avoid a scab.
wipe off any excess cream left before feeding your baby again. If nipple creams do not help, consider a hydrogel dressing.
Vasospasm and Reynaud’s Phenomenon
Vasospasm is a restriction of the blood vessels in the nipples. It is characterized as pain or stinging sensation after feeding, with a loss of color in the ends of the nipples. The nipple will often look compressed or in a ‘lipstick shape’ after feeding, and it can occur on one or both sides. It is usually due to the baby’s latch needing some adjustment, so do get some support if needed.
Remedies for Vasospasm and Reynaud’s Phenomenon:
Additionally, it can help to gently massage the nipples after feeding, to encourage the blood flow.
A warm compress will also increase the blood flow and will relieve symptoms more quickly.
Paracetamol and ibuprofen (assuming no other contraindications) are both compatible with breastfeeding if needed.
Raynaud’s phenomenon is a circulatory disorder typically affecting the extremities. However, you might not have noticed it affecting your nipples before breastfeeding. It can be triggered by cold, caffeine, nicotine, stress or certain medications. It has a characteristic tri-phasic colour pattern after feeding: starting usually with blanching of the nipple, through blue and red back to its normal colour. This might be harder to see on darker skin tones. Nipples may be painful during and after feeds and it will tend to occur on both sides. You can use the same strategies as above but might need medical help if it doesn’t help.
Thrush
Nipple thrush is probably over-diagnosed. It is more likely to occur after a course of antibiotics. It is a fungal infection identified by the following:
painful nipples after a period of pain-free breastfeeding
a shooting or burning pain in both nipples/breasts after feeds
nipples looking shiny, flaky and/or a different colour from the usual
Your baby may or may not also display symptoms of oral thrush, and have a nappy rash. This is usually white patches inside the lips and cheeks which are not easily wiped off. If only the tongue is white, consider latching issues first.
If either the mother or baby is showing signs of thrush, both need treatment to avoid re-infection.
Further information on thrush is here.
Blebs
A bleb, or milk blister, may form on the end of the nipple where a thin layer of skin grows over the end of a milk duct. They often resolve on their own, but if causing a lot of pain there are some simple self-help measures which can be taken.
Remedies for Blebs:
apply wet heat
rub the nipple gently with a damp cloth
express from that side to see if the plug will open
If the bleb persists, it may be necessary to visit a GP for a topical antibiotic.
Bacterial infection
If nipple trauma does not heal despite treatment, or pain persists, this might indicate an underlying infection. Scabs, crustiness or pus may be present, but not necessarily. If this happens, antibiotic treatment will be necessary, and some qualified support to help with optimal latching. Breastfeeding can continue as normal.
Eczema/dermatitis
People with eczema or dermatitis on the nipples will often have it on other areas of the body. It is helpful to identify the cause if possible, so that it can be minimised. You may need to speak to a GP or other healthcare provider for further treatment, especially if you experience scaling, crusting or sores on the nipples. A rare form of cancer called Paget’s disease is often mistaken for nipple eczema. If usual treatments have not improved the nipple’s condition after 3 weeks, it is important to be investigated further.
As with any cancer, early detection vastly improves survival, so never be afraid to seek medical attention if you are worried.
Information provided by: Tamzin West
BIO: Tamzin West is an IBCLC living in Derby, UK, and a mother of 3 children aged 9, 6 and 3. She has been working in breastfeeding support since 2014 and an IBCLC since 2020. She became a Lemonista in May 2021 and loves combining the Know Your Lemons training with all her breastfeeding knowledge.
