Post-Pregnancy Breast Changes: Doctor Explains When It Is Normal, When Should You Worry

With pregnancy, there are alterations in the level of hormones, estrogen and progesterone to sustain the pregnancy. The breasts also prepare for lactation under the influence of prolactin, and human placental lactogen. While these changes happen within the breast, it is important to be alert to the changes in the breast which are by and large normal but may sometimes require attention to exclude something more sinister developing in the breast.

What are the usual changes in breast during pregnancy?

1. Increase in size of the breast

It is usual for the breasts to increase in size from the first trimester onwards. Under the influence of estrogen and progesterone, there is increase in the number of ducts and the milk-producing units within the breast called lobules, which in turn manifests as increase in size of the breast. This increase is usually symmetrical and is accompanied by some heaviness or discomfort in the breasts which persists during pregnancy.

2. Enlargement of the areola

It is usual for the pigmented area around the nipple, called areola to increase in size and become deeply pigmented. It may also have tiny prominent nodules on it and prominent.

3. Nipple Changes and Colostrum Secretion

The nipples become more prominent and may darken. Nipples tend to become sensitive during pregnancy and if not taken care of in the second and third trimester, can become dry and crack, a problem that can hinder lactation and make the exercise painful. It is at this time that some women also notice a yellowish fluid discharge from the nipple called colostrum. This is not worrisome and is indicative of the breasts getting ready to produce milk.

Change in the feel of the breasts

During pregnancy, breasts often feel uneven and lumpy. This is usual.

One may even feel some lumps in the breast which are smooth and may wax and wane over time. If there had been well defined lumps like fibroadenomas in the past, they may enlarge under the influence of hormones

When should you worry?

While breast cancer during pregnancy is rare and most changes that happen during lactation are normal, one should be alert and aware to know when the line of normal has been crossed and a more sinister diagnosis is likely. Many a times the physiological changes can be confusing and cancer detection may be delayed. It is important to be aware and to look out for the red flags

1. A new persistent lump: A new lump that presents in one breast, is painless and persisting beyond 2-4 weeks and growing in size should not be ignored.
2. Changes in the skin: Dimpling of skin or thickening of skin causing it to resemble an orange peel texture may be indicative of an underlying malignancy. Redness occupying a large area of the breast, which does not resolve with antibiotics, should raise the suspicion of inflammatory breast cancer.
3. Abnormalities of the nipple: Recent onset of nipple inversion or scaling and ulceration of nipple should call for urgent evaluation. Any bloody or transparent discharge from the nipple should also prompt an investigation.
4. Lymph nodes in the armpit: If lymph nodes are felt in the armpit, and lare persistent and painless, the probability of lymph nodes involved by cancer should be entertained.

Low threshold for seeking help

Breast symptoms should not be ignored during pregnancy. All attempts should be made to arrive at a diagnosis.

Safe diagnostic tools include:

• Ultrasound: First-line modality; distinguishes cystic vs solid lesions
• Image guided core needle biopsy in solid lesions to confirm a diagnosis

It is important to know that even if a diagnosis of cancer is made during pregnancy, all is not lost. Most treatments that are available to non-pregnant women are safe for women from the second trimester of pregnancy, onwards. Such treatment can be undertaken safely while continuing the pregnancy. Close collaboration between the oncologists and obstetricians can help time the delivery with no detriment to either the child or the mother.

(By Dr Geeta Kadayaprath - Principal Lead, Apollo Athenaa Women's Cancer Centres)

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