Breastfeeding Complications

Overview

For all women, we undergo many physical changes in our lives. During puberty, we experience breast budding, and our first period. In late middle age, we undergo menopause. In between, we go through monthly cycles, which bring a whole range of physical and emotional changes- bleeding, breast discomfort, cramps, acne, mood swing, appetite changes!

For some of us, pregnancy is yet another major life event with the associated hormonal changes. These can be rather alarming for a first time mummy, so it’s good to be aware of what is normal. Only when we understand what is normal, can we then detect abnormalities!

Symptoms

  1. For some, breast tenderness, increased sensitivity may have been the first sign of pregnancy- this may continue in the whole 9 months
  2. The nipple and areola may become darker, and larger. Pimple-like lumps may appear in the areola.
  3. Breast size may go up
  4. Stretch marks may appear on the breast, same as any area where there is weight gain (thighs, tummy)
  5. When stimulated, there may be nipple discharge- clear sticky fluid, or even whitish/yellowish
  6. Sensation of shooting pain, needle poking, itchy skin etc may happen
  7. Increased lumpiness, especially in the upper, outer sides of the breasts
  8. Appearance of soft lumps near to the armpit areas- likely to be accessory breasts (“extra breast tissue”)

These changes are physiological- means they are normal in reaction to hormonal changes in pregnancy, and the purpose is to get the body ready for breastfeeding.

Increased lumpiness may be felt in certain parts of the breast, due to increased size of the milk ducts, it may be hard to tell the difference between this kind of expected lumpiness versus a breast lump. To care for the breasts, it’s a good habit to learn to do self breast self examination starting from puberty.

When to Seek Treatment

Breastfeeding complications come as a spectrum:

  • from block ducts or engorgement
  • which progress to mastitis if there is bacterial infection
  • And finally to become an abscess

Before and after each feed, palpate the breasts for any lumps, or areas of lumpiness, press on the nipples to get some milk flow. Subsequently, latch or pump as per your choice. After the session, palpable again- lumps or lumpiness due to milk should be softer now, or gone completely.

Any lumps that’s persistent should be checked by a doctor. Most breast specialists will be able to do an immediate ultrasound to confirm if this lump is due to retained milk cyst, or a solid lump; and then advise accordingly.

If you have redness or fever >38 degrees Celsius-  These are frequent signs of mastitis.please see a family doctor for a physical examination and to start antibiotics. With effective treatment, your symptoms should resolve after 2-3 days. If persistent, please go back to see the same doctor, and you may need to be referred to a breast specialist if your doctor suspects an abscess.

Diagnosis

When you consult a breast specialist, such as Dr Tan Yia Swam, she will conduct a thorough interview for a personalised risk assessment for cancer screening, followed by a physical examination.

Dr Tan Yia Swam will then recommend a radiology study, likely an ultrasound scan. Additional tests include sending expressed milk for culture, or needle aspiration of an abscess. In rare cases, if a condition such as cancer is suspected, Dr Tan may advise for a core needle biopsy.

It is essential to have a correct diagnosis, before we can give the correct treatment.

Treatment

For patients with mastitis, Dr Tan will review the duration and type of antibiotics. She will recommend a culture & sensitivity test, to better guide the choice of antibiotics, especially in cases where the recovery is slow.

If there is an abscess, bedside aspiration may be done. This is done in the clinic, with local anaesthetic, and a small needle (similar to the one for taking blood), to remove infected milk & pus to diagnose the infection, and to relieve pressure and pain.

Dr Tan will also prescribe antibiotics and anti-inflammatories which are breast-feeding safe, and share personalised tips on breastfeeding techniques.

Having had three kids, with different breastfeeding experiences for each one, Dr Tan is aware and sensitive to the significance and emotional bonding during breastfeeding. In partnership with lactation consultants, she strives to assist every mother to achieve their breastfeeding aims. Breastfeeding is different for every mother, and for every baby.

Prevention; tips for a smooth breastfeeding journey

The initial 2-4 weeks is frequently a stressful period for a new mummy. She has just delivered, and needs to recover from the childbirth. The vaginal/perineal area feels sore, there is on-off bleeding, bowel movements may be difficult. Some feel very hot and sweaty all the time. The body goes through major changes, and it doesn’t go back to what she remembers, but instead changes into a “new normal”- for some mummies, it can be overwhelming.

Emotionally, most of the attention goes to the new baby, so the mummy may feel neglected. Together with the hormonal changes, it is normal to feel the blues. We must be mindful that the blues don’t get any worse and become depression.

Breastfeeding is now strongly advocated, and known to be the best for baby, and mother. However, some women may have unrealistic expectations (from social media, or misinformation), and blame themselves for not being able to breastfeed, or internalize guilt when they feel that they don’t want to do it anymore.

Dr Tan Yia Swam believes that it is a personal decision, and it’s good to give yourself (and the baby) 6-8 weeks to learn each other’s feeding style well, before the “sweet spot” of breastfeeding may happen.

Breast care during breastfeeding is not much different from BSE (breast self examination): Before and after each feed, palpate the breasts for any lumps, or areas of lumpiness, press on the nipples to get some milk flow. Subsequently, latch or pump as per your choice. After the session, palpable again- lumps or lumpiness due to milk should be softer now, or gone completely.

Any lumps that’s persistent should be checked by a doctor. Most breast specialists will be able to do an immediate ultrasound to confirm if this lump is due to retained milk cyst, or a solid lump; and then advise accordingly.

At the nipple area, one can apply nipple cream/ointment, or breast milk to minimize nipple dryness and soreness.

For the skin, consider a moisturizer, gentle massage; good bra support may also help to minimize itch, dryness and stretch marks.

Dr Tan wishes for all mummies to enjoy their motherhood!

Consult Our Doctor

Dr Tan Yia Swam Breast & General Surgeon

MBBS (Singapore), M.Med (Surgery), FRCS (Edin), FAMS (Surgery)

FAQs

Avoiding standing still for long periods will reduce the pressure in the veins in the legs. For people who need to stand for long periods at work, wearing compression stockings will reduce the pressure build up in the legs.

The ultrasound will be done of the legs from the thigh to the calves. Please wear or bring along a pair of shorts to change into for the scan.

Have a question or need a second opinion?

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