Friday, August 22, 2008

Taking Your Lumps Seriously…

By Jessica Sacher, RN, MN, IBCLC

Few things are more frightening to any woman than finding a lump in her breast. Finding a lump while breastfeeding in enough to create a state of panic. Most of us are aware of the American Cancer Society's advice to check our breasts and follow up with lumps or nodules in our breasts. Just because a woman is breastfeeding does not mean that she is "immune" to more ominous findings. The questions nags at us: Is it a plugged duct? Is it engorgement? Is it something else?

In the early days of breastfeeding, the breasts are undergoing many rapid changes. The milk comes in and we experience engorgement. Sometimes we can palpate the lumps and bumps in the breast in the immediate days following the birth. Normally these "lumps" become smaller and imperceptible as the baby nurses and removes the milk. In the next several days the breasts adjust to the demands of the baby and the lumps that were of concern no longer seem important. But what if you have a lump that does not get smaller after nursing or pumping?

The prudent course of action is to follow up with any lump that persists for more than 2 or 3 weeks. We at The Pump Station & Nurtury always recommend that a woman report this to her doctor and seek evaluation. A plugged duct should not last 2-3 weeks. A woman may experience lumps in different locations in her breasts that resolve with feeding or pumping, or a woman may be prone to repeated bouts of plugged ducts, but this is different than a lump that persists for 2 -3 weeks. The hallmark symptom of a plugged duct is tenderness or pain. It is often the precursor to mastitis (breast infection). An unresolved painless lump needs to be evaluated.

Perhaps it seems overly aggressive to suggest that a breastfeeding woman be evaluated after only a couple of weeks, but it is better to error on the side of caution. Several years ago, a mother with a one year old came to see me with a "plugged duct" that she’d had for several months. She had done all the right things: saw her primary doctor, her OB, and finally a surgeon. The problem was that not one of these health care providers had ever examined her breast. By the time I saw her, the "plug” occupied over half of her breast, and it wasn't a plugged duct. She had breast cancer, but because she was breastfeeding no one took her symptoms seriously. She went on to have treatment and did well, but if someone had just evaluated the lump she would have been diagnosed so much earlier. Finding breast cancer is the exception not the rule, but it has made us very cautious and proactive. If your doctor doesn't suggest an ultrasound, ask for one. If your doctor doesn't examine your breast, ask him/her to evaluate what you are feeling. Thankfully most breast lumps are benign and we can breathe a sigh of relief, but it is never wise to assume that something is nothing until proven otherwise.