Expert: Sally Wendkos Olds - 9/7/2009

Question
QUESTION: I have a few very painful lumps on my top outer left breast. I keep nursing and I put heat on the lump but it's not going away.
It is so painful that I am having a hard time wearing a bra. It hurts when the bra rubs against it. I had an ultrasound and it's not a cyst. My doctor said there is nothing they can do. Please let me know if there is anything I can do. Best regards

ANSWER: Dear Sylvia,

I'm so sorry to hear about the problems you're having. It's hard to give you an answer, because there's so much that I don't know. Answers to the following questions can help me better understand your situation:

* How old is your baby?
* When did the lumps appear?
* How long have they been there?
* How big are the lumps?
* How many lumps are there?

Did you actually get examined by an obstetrician who told you there's nothing you can do? If so, I suggest that you consult another doctor. You could also find a lactation consultant or a La Leche League leader near you, who might be able to diagnose your problem and offer suggestions for fixing it.

Meanwhile, you might try applying cold instead of heat. Cold can reduce the swelling, while heat increases the blood flow. Some women get relief from engorgement from applying green cabbage, which might help with these lumps as well. You could also try massaging your breast from the outer edges to the inner (towards the nipple).


Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.



---------- FOLLOW-UP ----------

QUESTION: Dear Sally,

Thank you for following up with me!

* How old is your baby?- She is nine weeks
* When did the lumps appear? - They appeared over a month ago.,  
* How long have they been there? I had a blocked duct that went away but the lumps are still there.
* How big are the lumps? - There are a few very small lumps and one lump that is small but much bigger than the others.  smaller than a pea

I have been using heat before a feeding and cold after.  But I was afraid to put cold on the lumps because I read you shouldn't put cold on a plugged duct and I'm not sure what is causing my pain.

Also my breast is producing a lot less milk.  I am going to a La Leche League meeting on Wednesday and I will ask for help but in the meantime I would be grateful for any additional advice.

The doctor did exam me but he didn't want to look at my breast.  He did it with his eyes closed and had a hard time helping me.  He told me to ignore blocked ducts and they may go away.

Warm regards,

Sylvia

Answer
Dear Sylvia,

I'm glad you're going to a La Leche League meeting tomorrow. Maybe someone there can recommend an obstetrician/gynecologist who is familiar with the breast issues experienced by breastfeeding women. If you went to an ob/gyn, he obviously is not knowledgeable in this area, and you should get a second opinion. If you went to your pediatrician, his expertise would be for your baby's health, not yours. If there is a women's health clinic near you, they may have a knowledgeable ob/gyn on staff.

You have had these lumps for about 5 weeks, so if they had been plugged ducts that would have gone away on their own, they would have disappeared by now. The fact that they have not means that you should get some knowledgeable medical help soon. It's probably not a serious health problem, but the fact that it's uncomfortable for you and producing less milk for your baby means that you really should find out what the cause is for these lumps and get treated.

Meanwhile, I'm attaching an excerpt from my book (see below) on dealing with plugged ducts. If there's anything here that you haven't done yet, it's worth giving it a try.

Please let me know how you are doing. Thanks, Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.
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Clogged Duct (Plugged Duct, “Caked” Breasts)
In this condition, which can occur any time during nursing, one or more milk ducts are blocked so that the milk cannot pass through them. If you develop a clogged duct, you’re likely to find a small reddened lump on your breast that’s painful to touch. If not treated, this condition can lead to a breast infection, so take immediate measures, as suggested below.
• First, continue to nurse. If you stop suddenly, your breast is likely to get too full, the condition will worsen, and infection may result.
• Be sure your bra (or other clothing, like a T-shirt or sweater) is not so tight that it’s pressing on the milk ducts. Try a bra in the next larger size. Or try going without one, at least while you’re nursing. Also check other items that may be putting too much pressure on your breasts, like a baby carrier or a shoulder bag.
• Breastfeed more often and for a longer period of time, so that your baby can help you empty the breast, release the lump, and unclog the duct.
• Change your position with every feeding, so that the pressure of your baby’s suckling will hit different places on your breast, exerting pressure on different ducts.
• Express or pump milk from the affected breast after each feeding if your baby has not nursed long and vigorously, to get out as much milk as possible.
• If dried secretions seem to be covering your nipple openings, wash them off very gently after each nursing with a piece of cotton saturated with warm water.
• Offer your sore breast first, so that your baby will drain it more thoroughly.
• Apply moist heat several times a day (with a moist-heating pad, a hot water bottle, hot wet towel or washcloth, disposable diaper filled with hot water and squeezed out, or tub bath or shower). Be careful not to burn yourself!
* Gently massage the area of the clogged duct, especially after moist heat treatment.
* Try ultrasound at a physical therapy office or sports medicine clinic for one or two consecutive days. If the therapist is not familiar with this use of ultrasound, ask your lactation consultant to recommend the dosage.
• Rest as much as you can.
• Don’t sleep on your stomach, which puts pressure on your breast.
• If your baby refuses to nurse on the breast with the clogged duct, see your obstetrician. There may be a changed taste in the milk from that breast, which may be a sign of an infection or other problem.
• If a lump remains for more than three days, see your obstetrician. While the lump is probably related to breastfeeding, it may not be and must be looked at promptly.
• If you repeatedly suffer from clogged ducts, consult a lactation specialist to reevaluate the way you’re holding your baby or the way your baby is suckling.