Breast Lumps When Breastfeeding: Causes and Treatment

Breast engorgement: Engorgement implies full and tender breasts, which is quite normal during the initial few weeks when your milk first fills the breasts; however, lumpy swollen breasts after that may imply that the milk is not drained equally from all the areas of the breast by your baby. Contact your lactation consultant to determine the cause of breast engorgement and take necessary steps to relieve the engorgement.

Blockage of milk duct: Blockage of a milk duct prevents milk from flowing freely into an area of the affected breast and may result in engorgement. A blocked milk duct can result from anything that hinders in the good drainage of breast such as a shallow latch, poor positioning, tight bra that presses on the breast glands or not breastfeeding on demand. Previous surgery on breast or any scar formation, piercing of the nipple or a blocked pore of the nipple can also cause blockage of a milk duct.

Mastitis: If timely treatment for blocked ducts or engorgement is not provided, the mother may show symptoms of mastitis or inflammation of the breasts. This is characterized by pain in the breasts and flu like symptoms such as feeling shivery and achy. Some other symptoms include heat, soreness and swelling in the breast, areas of pink or red skin on the breast surface (may present as red lines or streaks), a tender spot or sore lump inside the breast, increased levels of sodium in breast milk etc. Usually one breast is affected by mastitis. If left untreated, mastitis will lead to bacterial infection of the affected breast requiring antibiotics.

Breast abscess: One of the causes of lumps in breast while breastfeeding, a breast abscess is usually felt as a swollen, very painful lump inside the breast. The abscess is associated with the symptom of high fever. The abscess is actually a pocket of pus that usually develops following mastitis or engorgement that was not managed timely. The diagnosis of a breast abscess is made by an ultrasound and it requires immediate treatment.

Galactocele: A harmless cyst filled with milk present in the breast is referred to as a galactocele. It feels like a round, smooth, movable lump inside the breast. The contents in a part of a milk duct gradually develop the consistency of oil or butter and form a galactocele. It is usually not tender or painful. It can be diagnosed by performing an ultrasound or by doing fine needle aspiration biopsy. The cyst disappears after you stop breastfeeding.

Fibrocystic changes of the breast: These commonly occur and include fibromas, cysts, hematomas and lipomas. These are usually noticed as a thick, sensitive or bumpy area in the breast. If your periods have already started, then symptoms of fibrocystic breasts can worsen during menstruation.

Breast cancer: A lump in breast while breastfeeding is rarely a cancer, but you should seek medical advice if the lump is persistent (present even after one week), is getting larger, is hard and firm or if dimpling of the skin is present.

Diabetic mastopathy: These are benign lumps present in diabetic females. They do not hinder breastfeeding. They are usually movable, painless lumps and their shape is irregular. 

Breast fat necrosis: Necrosis is a medical term used for dead tissues. Breast fat necrosis can be one of the causes of lumps in breast while breastfeeding. It occurs following bruising trauma, a needle biopsy or breast surgery. It’s presented as a rounded firm lump, which is painless. Confirmatory tests include mammogram, ultrasonography, fine needle aspiration, core biopsy and vacuum assisted excision biopsy. If your breast lump is diagnosed as breast fat necrosis, you won’t need treatment as fat necrosis lumps usually go away spontaneously. If the lump is full of oily fluids, it can be aspirated with a needle and syringe to relieve discomfort. Fat necrosis doesn’t affect breastfeeding and it will not cause any harm to your infant.

The treatment depends on the cause of the lumps while breastfeeding.

• To relieve engorgement or a blocked milk duct, breastfeed your baby frequently at least 8-12 times in a day. Get your baby’s positioning and latch as good as possible to clear the milk properly from the breast.

• In case your baby is not feeding well, hand express or pump your milk frequently and give it to the baby. Hand expressing will help in the prevention of mastitis or blocked ducts.

• You can also apply cold ice pack (for instance, crushed ice placed in a damp cloth or frozen peas) on the sore areas for 15-20 minutes to help relieve inflammation. You can also put chilled cabbage leaves inside the bra around the affected area to relieve inflammation.

• During pumping or breastfeeding, gentle massage and breast compression of the areas that are engorged can help in releasing more milk.

• While breastfeeding try different positions of breastfeeding. This will help drain the blocked duct and relieve engorgement.

• You can use a heated pad or hot compress on the blocked duct before breastfeeding.

• You can take over-the-counter anti-inflammatory medicines to relieve pain and reduce inflammation.

• Take proper rest and take care of yourself. Eat properly and drink lots of fluids.

• A breast abscess needs treatment by needle aspiration, surgical incision and drainage or catheter drainage. Abscesses smaller than 3 cm diameter are treated using needle aspiration and abscesses greater than 3 cm diameter are treated using catheter drainage.