Breast Changes During and After Pregnancy: Have I Got Breast Cancer?

The Breasts and Nipples

Internally, breasts consist of two main parts, namely lobules, which carry out milk production and, therefore, known as milk-producing glands, and the other part is known as ducts, which are the tubes that carry milk to the nipple. These two parts are surrounded and protected by glandular, fibrous, and fatty tissue.

Externally, breasts have two parts – nipple and areola (the darker skin area around the nipple). The surface of the areola is covered with some small raised bumps, which are called Montgomery glands. These glands produce fluid to moisturize the nipple.

Why Do Breasts Change During Pregnancy?

Breast changes during pregnancy are mainly due to hormonal changes that prepare the breast for milk production. The milk-producing glands and ducts develop and the breast tissue becomes more vascular. These changes can make the breasts larger, fuller, more sensitive, and sometimes lumpy or uneven.

These changes do not occur at exactly the same time or to the same degree in every woman. Cases may differ from woman to woman. Some women notice breast tenderness very early in pregnancy, while others notice relatively little change until later in pregnancy.

Breast changes during pregnancy are usually normal. However, a new lump or other unusual change should not automatically be attributed to pregnancy. Persistent or concerning changes should be discussed with a healthcare professional.

Breast Changes During Pregnancy

Breasts change a lot during pregnancy to prepare them for feeding the baby. An increase in hormone is responsible for these changes. The changes may include the following:

Tenderness in the Nipple and Breast

During pregnancy, the hormones in the body prepare women’s breasts for lactation. In this process, the milk ducts become bigger in size and stretch when they fill with milk early in pregnancy. All of this causes the breasts to be more sensitive, particularly your nipples. This may cause discomfort while touching, walking, and lying down. Many women try out the following things to ease the discomfort and tenderness:

• Wearing a supportive and well-fitting maternity bra.
• Wearing a cotton bra.
• Being extra careful to avoid knocking the breasts

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Bigger Breasts During Pregnancy

Breast growth is a significant change in the breasts during pregnancy. During early pregnancy (around 6 to 8 weeks), breasts may get bigger and continue getting bigger throughout the pregnancy. In the case of the first baby, the cup size may increase by 1 or 2. Women may also feel itchiness in breasts during pregnancy due to stretching of the breasts.

Increased Size of Nipples and Areola

With an increase in breast size, there is a significant increase in the size of areolas and nipples. During pregnancy, the body produces hormones that prepare the woman to breastfeed.

Changes in the Color of the Nipples and Areola

Darkening and enlargement of areolas (the area around your nipples) are among the earliest signs of pregnancy. As the pregnancy progresses, the areolas may grow to bigger circles, and the color may darken. These changes may or may not remain after giving birth to the child.

Bigger and More Noticeable Montgomery Glands

Montgomery’s tubercles are the raised spots around your nipples. This is also considered one of the first symptoms of pregnancy. However, these symptoms may be noticeable even before the missed period. Breast changes during early pregnancy prepare a woman’s body for the big day.

Stretch Marks

With an increase in breast size, stretch marks on breasts during pregnancy may appear on the skin. The stretch marks are dark at first, but with time they fade and become less noticeable.

Milk Production

Breasts in women are able to produce milk during the second trimester of pregnancy. And this is the reason some women lactate during pregnancy.

Colostrum Before Delivery

The breasts begin preparing for milk production well before delivery. During pregnancy, the breasts may produce colostrum, a thick, nutrient-rich fluid that is different from mature breast milk.

Some women notice small amounts of colostrum leaking from the nipples during pregnancy, while others do not notice any leakage. Both can be normal.

Not leaking colostrum during pregnancy does not mean that a woman will have difficulty breastfeeding after delivery. Milk production and breastfeeding are influenced by several factors after birth, including effective milk removal and how frequently the baby feeds.

At this stage, breasts produce colostrum, and you may notice occasional leakage from the nipples. But this is not a thing to worry about; in fact, it is good news because these common breast changes during early pregnancy signal everything is going right. And the body is preparing itself to nourish the baby after birth.

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Breasts Changes After Pregnancy

Following are some of the changes that the woman body notices after Pregnancy i.e., after giving birth to the baby:

Sore and Cracked Nipples

Initially, it is very difficult with a newly born baby to make him suck the whole areola instead of just the nipple. This may lead to sore and cracked nipples because the baby does not attach to the breast correctly. When the baby sucks the nipple only, his tongue or roof of the mouth rubs on the nipple, this can make the nipples sore and cracked.To heal the nipples, get support from a midwife for making the baby lactate correctly.

Breast Engorgement

Breast engorgement is common in the first days after delivery as milk production increases, although not every mother experiences significant engorgement. This happens when the breast becomes overfull of milk. The symptoms of breast engorgement may include hard, warm, and throbbing breast. Breast engorgement may be eased by:

• Feeding your baby on demand.
• Releasing small amount of milk via a breast pump so that it becomes easier for the baby to attach to the breast.
• Wear a well-fitting nursing bra that gives full room to the breasts and does not restrict them.
• Reducing the breast pain by applying chilled cabbage leaves to the breasts after feeding.
• Taking  paracetamol at the recommended dose during breast pain, which is safe during breastfeeding.

Frequent breastfeeding and ensuring that the baby is able to latch effectively can help with milk removal and comfort. If the breasts become so swollen that the baby cannot latch properly, a lactation consultant or healthcare professional can help with positioning and milk expression.

Expressing only enough milk to relieve discomfort may be preferable to repeatedly emptying the breasts solely to treat engorgement, because excessive milk removal can contribute to an oversupply.

Blocked Milk Ducts

Milk ducts may get block while breastfeeding. This can sometimes happen when you stop breastfeeding. Blocked milk ducts are accompanied by a small, painful, hard lump or a bruised feeling. Things that may help ease the problem may include:

• Feeding the baby more often.
• Changing position when you’re feeding so that the area can be fully drained.
• Massaging the lump towards the nipple while the baby is feeding
• Avoiding tight-fitting bra and clothes so the milk can flow freely

Mastitis

A continuous condition of breast engorgement and blocked milk ducts may lead to inflamed or infected breasts. This is called mastitis. In this condition, the breast may become red, hot, and painful. To ease the symptoms of mastitis, continue to breastfeed frequently, which helps to clear the infection and is not harmful to the baby.

Mastitis During Breastfeeding: Inflammation Does Not Always Mean Infection

Mastitis refers to inflammation of the breast and can occur during breastfeeding. Not every episode of mastitis is caused by a bacterial infection.

Breast inflammation may cause a painful, swollen, warm or red area of the breast and may occur along with breast fullness or difficulty with milk removal. Some women also develop fever, chills or flu-like symptoms.

Supportive breastfeeding care and effective milk removal are important, but worsening symptoms, persistent fever or significant illness may require medical assessment. Antibiotics are not automatically necessary for every episode of breast inflammation; a healthcare professional can determine whether bacterial infection is suspected and whether antibiotic treatment is appropriate.

A painful breast lump that does not improve should also be evaluated because mastitis-like symptoms can occasionally have other causes.

Breast Abscess

If mastitis or such infection is not treated on time, it may develop an abscess (a collection of pus) in the breast. Although breast abscesses are not so common, careless behavior may give rise to such condition.

Antibiotics are usually recommended to treat abscesses. They are also drained using a needle and syringe. In case of a large abscess, a small cut is made to allow the pus to drain away.

Thrush

Thrush is a yeast infection caused by a microorganism Candida albicans that can occur on the nipple and areola during breastfeeding. In this condition, the following symptoms may occur:

• Itchy, painful, and sensitive nipples.
• Shooting pains deep in the breast that start after feeding and can last for a few hours.

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What If You Find a Breast Lump During Pregnancy?

Finding a breast lump during pregnancy can be worrying, but many breast lumps are caused by benign changes associated with pregnancy or breastfeeding.

Hormonal changes can make the breasts feel fuller, denser or lumpier than usual. Nevertheless, a new or persistent lump should not simply be assumed to be a normal pregnancy change.

If a lump persists, grows, feels unusual, or is accompanied by other changes such as nipple discharge, skin dimpling, redness or a change in breast shape, speak with your doctor or obstetric care provider.

Breast problems can be evaluated during pregnancy. Depending on the clinical findings, a doctor may recommend breast ultrasound and, when appropriate, other imaging or a biopsy.

Can Breastfeeding Reduce the Risk of Breast Cancer?

Breastfeeding reduces the risk of breast cancer greatly, especially if a woman breastfeeds for one year or more. Doctors recommend continuous breastfeeding for the first six months, which is essential for the baby. But if this breastfeeding process is extended to one year or more, it may be good for both the mother and the baby.

When a Breast Lump Does Not Go Away

A breast lump that occurs during breastfeeding may be related to milk stasis, inflammation, a cyst or another benign condition. However, a lump that persists despite improvement in breastfeeding-related symptoms should be examined by a healthcare professional.

Breastfeeding should not be assumed to protect someone from all breast diseases. Persistent lumps, unusual nipple discharge, skin changes or other concerning breast changes deserve appropriate evaluation.

Which Breast Changes During Pregnancy Should Be Checked?

Most breast changes during pregnancy and breastfeeding are normal. However, speak with a healthcare professional if you notice:

• A new lump that persists or grows
• A change in the shape or size of one breast
• Skin dimpling or an unusual change in the skin
• Persistent redness or swelling
• Nipple inversion that is new or unusual for you
• Nipple discharge that is bloody or otherwise unusual
• Persistent breast pain in one specific area
• A lump in the armpit

These changes do not necessarily mean breast cancer. Many have benign causes. The important point is that persistent or unusual changes should be assessed rather than automatically attributed to pregnancy or breastfeeding.

References

1. American College of Obstetricians and Gynecologists (ACOG). Breastfeeding Challenges. ACOG Committee Opinion No. 820. Obstetrics & Gynecology. 2021;137:e42–e53. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/02/breastfeeding-challenges
2. National Cancer Institute (NCI). Understanding Breast Changes and Conditions: A Health Guide. National Institutes of Health. https://www.cancer.gov/publications/patient-education/understanding-breast-changes
3. National Cancer Institute (NCI). Breast Cancer Prevention (PDQ®) – Health Professional Version. National Institutes of Health. https://www.cancer.gov/types/breast/hp/breast-prevention-pdq