During the nine months of pregnancy, the body prepares for breastfeeding. Therefore, the breast undergoes physiological changes due to hormonal fluctuations, which increase its size and water content. These changes can appear as early as a week after conception and continue until breastfeeding, while the breasts return to their original shape 3 months after stopping.

“It is important to note that these changes vary from woman to woman and manifest clinically with increased density, nodular morphology and sometimes with the presence of palpable nodules. The resulting clinical difficulty concerns not only diagnosis and treatment, but also the impact they can have on the fetus. The main goal of clinical evaluation of palpable breast lumps during pregnancy and lactation is to rule out malignancy. As more women delay childbearing, the incidence of breast cancer in pregnancy increases. Despite the fact that breast cancer during pregnancy, according to the American Cancer Society, is rare, it is important to point out that 20% of palpable lumps during this period are malignant,” says Ms. Andriana Kouloura General Surgeon – Breast Surgeon Director of the Breast Clinic LITO continues:

“For this reason, women should undergo periodic breast examinations during prenatal care. Apart from palpation, breast ultrasound is the examination of choice, as it has no effect on the fetus. Mammography during pregnancy, although not contraindicated, if there is adequate coverage of the abdomen, is only requested when there is a strong suspicion of malignancy. However, its diagnostic value is limited due to the changes in the breast. Breast magnetic resonance imaging (MRI) is not indicated as the safety of the use of the contrast agent in relation to the fetus has not been fully established. In breastfeeding, however, it is acceptable, although its sensitivity is reduced. The biopsy, where it is necessary for the diagnosis, can be performed using a cutting needle (Core Biopsy), while the use of local anesthetic is considered safe both during pregnancy and during lactation,” he adds.

What can these lumps be and how are they treated?;

Clogged milk duct: In the second and third trimesters, it is the most likely cause of a palpable breast lump. Clinically it can be hard, mildly painful and tends to disappear after a few days and may return with breastfeeding. Wearing an appropriate bra along with warm compresses and massaging the area relieves pain and helps the swelling go down. However, if it persists or worsens, clinical assessment and further investigation will be needed.

Lactation adenomas: These are benign hormone-dependent masses. They are common (about 70% of palpable findings), resemble fibroadenomas, appear as palpable, mobile, painless masses mainly during breastfeeding and rarely before the third trimester, and may resolve spontaneously with the end of breastfeeding. They are managed with close monitoring and if there are suspicious features, a biopsy should be done.

Lactoceles: The most common breast lump during and after breastfeeding. Clinically, it is a painless mass and can affect both breasts. It may resolve automatically, however, the evacuation puncture of its contents has a diagnostic and therapeutic role and should always be accompanied by imaging tests.

Fibroadenomas: In the already existing fibroadenomas, due to the increased vascularity, an increase in their size by 20% can be observed. This rapid growth sometimes causes focal pain. Any new or suspicious finding should be confirmed by puncture and biopsy.

Cysts: They appear with the same frequency during pregnancy and breastfeeding as in the normal breast. They are more common in young women. Management of complicated cysts involves close monitoring and/or puncture, and less commonly a biopsy may be needed.

Mastitis or breast abscess: It happens more often during breastfeeding, even months after it starts. The most common pathogens are staphylococcus and streptococcus or Escherichia coli. Diagnosis is clinical, although imaging is indicated if abscess or malignancy is suspected. Treatment of a breast abscess includes diagnostic and therapeutic puncture, culture of the fluid, and appropriate antibiotic therapy while the abscess is persistent or, if larger than 3 cm, surgical debridement. If after appropriate treatment the findings do not subside, the possibility of cancer must be ruled out