Lump in Breast

Ask Anne…

Question: I’m breastfeeding my two year old daughter and don’t plan to stop until she’s ready to wean. We both still enjoy nursing, and she is allergic to cow’s milk, which is another reason I want to continue breastfeeding.

I’ve had a small, painless lump in my right breast for two months. During my yearly physical today, I asked my family doctor about it.

He told me to stop breastfeeding and  come back in about a month. In a very scathing tone, he told me that I should have given up on nursing ‘long ago’, and said that it was obvious that I had ‘come to the end of the road’ as far as breastfeeding goes.

When I questioned this (bearing in mind the lump has been there for two months already) he told me that “if I insisted”, he would refer me to the breast clinic at the hospital for an ultrasound,  but that they would not do any tests while I was still breastfeeding.

I know I will have wean at some time, but I was hoping to wait until my daughter and I were both ready. I’m worried about the lump, but I want to continue nursing. Is it true that I have to wean my baby before I can  have an ultrasound?

Answer: It sounds like your doctor is not very knowledgeable about breastfeeding. There is absolutely no reason for him to tell you to wean your baby abruptly, except for the fact that it sounds like he seems to have a personal bias against nursing an older toddler. I’m sure that he is unaware of the many benefits of extended breastfeeding, as are many medical professionals. A doctor who is  ’breastfeeding friendly‘ would not give you that misinformation.

During lactation, it’s not unusual for the breasts to be “lumpy”. There is more lymph fluid and more blood in the lactating breast, and the milk ducts fill and empty many times each day.

Most of the time, if not caused by a blockage, lumps in a nursing mother’s breasts are galactoceles (benign milk-retention cysts) or by inflammation due to plugged ducts or mastitis.

Clogged, blocked, or plugged ducts result when the milk ducts don’t drain effectively, and swelling and inflammation occur. Plugged ducts can result in a breast infection, but in most cases,  just come and go without causing any real medical problems.

It is extremely rare for a breast lump to be cancerous, but it is possible, so you did the right thing in asking your doctor to check it out in case medical treatment is needed.

Before having any testing done, I’d suggest that you find a doctor who is knowledgeable about the lactating breast. If he or she thinks that the lump needs to be investigated further, there are many diagnostic tests that can be done while you are nursing, including ultrasounds, mammograms, X-rays, CAT scans, fine needle aspiration, and biopsies. None of these procedures require that you interrupt nursing even temporarily.

If you are evaluated by a doctor and no medical explanation can be been found, and you haven’t developed any other symptoms in months (such as pain, fever, or sore nipples), then this may be a chronic condition that will continue for as long as you breastfeed.  In this case, observing the lump for changes and using comfort measures such as heat and massage may be helpful.

Dr. Jack Newman says that in some cases of chronic plugged ducts, “Therapeutic Ultrasound” may be helpful. This treatment may be administered by an experienced ultrasound therapist at a sports medicine or physiotherapy clinic, but it may be difficult to find someone who is familiar with the procedure.

Some nursing moms have used the flat end of an electronic toothbrush to administer an ultrasound treatment at home to help unclog the ducts. It won’t hurt to try, and it may help.

If the lump isn’t painful, then your doctor may decide to just observe it and see what happens. Remember that it is very rare for breast lumps during lactation to be caused by anything more serious than a milk filled cyst or a plugged duct.

Once your little girl weans, your breast tissue will go back to its pre-pregnant state, and the lump should disappear, although it may take some time for your milk to dry up completely.

Anne Smith, IBCLC
Breastfeeding Basics