Pregnancy, Lactation and Breast
The birth of a child is the phase in a woman’s life when the breasts are called upon to fulfill their true mission of nursing the infant. A series of hormones, estrogen, progesterone, prolactin and oxytocin act on the predominantly hormone-sensitive organ, the breast, causing significant changes. Thus, in the breast in pregnancy, various symptoms of breast diseases appear, which can cause stress to the pregnant woman and require special expertise on the part of the mammologist.
Pregnancy:
With the onset of pregnancy the swelling of the breast gland begins. From the 6th to 8th week, an increase in its size is evident. This causes pain in the breast, one of the earliest symptoms of pregnancy. The woman feels it as a weight or tenderness in the breast or as a nipple pinch, which is not permanent. The pain can subside if we provide proper support with a pregnancy bra or sports bra, which is usually a larger size than before pregnancy. Breast weight support may also be necessary during sleep. Examination by her breast surgeon will only be required if the pain is constant, localized to a specific part of the breast and accompanied by a lump.
Along with the growth of the gland, the skin of the breast expands, resulting in dry skin and itchiness, primarily at the nipple. These symptoms are treated with moisturizers and do not particularly persist as the skin adapts to the changes. In addition to increasing in size, the nipples will begin to become more dark and more uneven in texture due to the dilation of the Montgomery’s glands in the areola, completely normal phenomena. In contrast, other nipple changes, such as the appearance of skin lesions, red spots, or bleeding, should be investigated immediately by the woman’s breast surgeon to rule out other diseases.
In the pregnant woman’s body, in order for the fetus to be supported, an increase of up to 50% in the amount of blood occurs. This, combined with the increased metabolic needs of the breast, results in hyperactive circulation in the breast that is evident by the expansion of the veins in the skin of the breast. This is not a worrying sign, they are expected to decrease after delivery and return to normal after the end of breastfeeding. The appearance of pain or soreness on the veins are symptoms for which we should be seen by our breast surgeon.
By the 16th week of pregnancy, the breasts begin producing breast milk. This is a secretion that continues until a few days after birth, when milk appears. Colostrum is a yellowish liquid that contains many antibodies to boost the newborn’s defenses. It is normal to have an outflow due to high production even before birth. There are special nipple patches to avoid staining of clothes. In the third trimester of pregnancy, bloody nipple discharge may also occur as a side effect of the large growth of the breast gland. The presence of blood in the nipple should not be confused with colostrum, as it requires constant monitoring by the woman’s breast surgeon to rule out other pathology.
The incidence of breast tumours in pregnancy is probably well known. It is quite common for a known breast lump to grow in size during pregnancy or for new ones to appear. This occurs due to a flurry of hormonal changes and examples of such benign lumps are fibroadenomas, amaranthomas and lactational adenomas. All known lumps or any new lumps should be monitored by your breast surgeon, who will decide which diagnostic tests are necessary, starting with breast ultrasound. And in pregnancy, the only conclusive way to diagnose a tumour is a breast biopsy under ultrasound guidance, but it is performed after discussion with your specialist doctor. The reason we don’t lower our defences is that unfortunately breast cancer occurs in 1/3,000 pregnancies. As always, the most important consideration is early diagnosis. Such cases are necessarily treated with the collaboration of a mammologist, health psychologist, gynecologist and oncologist.
One rare manifestation of breast size increase in pregnancy is giantomastia. It is a dangerous condition that will be diagnosed due to abnormal breast growth and requires very specialized care by the woman’s breast surgeon, in collaboration with other specialties.
GALUGHIA:
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The time for breastfeeding is, at long last, coming. If a woman breastfeeds, she enjoys the privilege of bonding psychologically with her infant, providing him with the best resources for the beginning of his life and she herself has a statistically lower chance of developing breast cancer in the future. There are of course some problems, mainly of an inflammatory nature, that complicate breastfeeding.
If the infant is not grasping the nipple properly and the mother has no experience to guide her, then it is likely that bruising of the nipple will occur. In addition to the obvious pain this causes during breastfeeding, open sores are an easy entry point for microbes to enter the breast, resulting in the development of lactation mastitis, as we will see below. A midwife or an experienced mother is the most appropriate person to advise on the correct positioning of the baby. Pain and itching in the nipple, however, can also mean the presence of nipple fungal infection, a condition that requires treatment for both mother and baby.
Another common problem during lactation is blocked breast pores leading to local or total swelling of the breast, pain and difficulty breastfeeding. Warm compresses, massage of the nipple and breast and encouragement of the baby to breastfeed are applied. If these fail it is necessary to consult our breast surgeon, who will consider ultrasound-guided evacuation of the obstructed ducts. When a blocked duct is left untreated for a long time, its contents become very dense. It is then called a galactocele. The high density of the fluid makes it difficult to ultrasound-guided evacuation of the galactocele, and sometimes surgery may be required to remove the blocked duct.
The stagnant milk due to obstruction is the most important cause of developing lactation mastitis. Fatigue, pain, redness and high fever occur, requiring milk evacuation and very often antibiotic treatment. If treatment is not applied in time, then mastitis will progress to breast abscess requiring from paracentesis in the doctor’s office to surgery under general anesthesia in severe cases. The sooner we see our specialist breast surgeon, the less chance of developing an abscess requiring surgical opening.
AND AFTER:
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We come to the after, when the pregnancy is complete. Whether there has been breastfeeding or not the breast will never be the same as before. Changes are seen in the shape, size and volume of the breast and in the size and shape of the nipples. It is good to make peace with our body image as it has been shaped over the course of our lives. However, women who cannot come to terms with these changes can talk to their breast surgeon to learn about the available surgical mastopexy techniques – more or less invasive – by which their breasts could regain their pre-pregnancy image.
CONCLUSIONS:
We recognize that the periods of pregnancy and lactation are very critical for a woman’s breasts. We recommend breast screeningbefore any planned pregnancy. Breast palpation, breast ultrasound, digital mammography at older ages and, if a lump is discovered, breast biopsy with a cutting needle on any solid breast lumps is needed. This screening should be done in a specialist breast clinic by a qualified breast surgeon and will provide a benchmark for changes that occur later.
Once pregnancy occurs, it is important to have a breast self-examination, so symptoms such as the appearance of lumps, skin lesions and nipple bleeding are the most important signs that need immediate investigation so that we can guarantee the health of both mother and baby.
