This article is designed to help you
understand the possible changes that can occur to your breasts during pregnancy
and after giving birth.
Hormones released
during pregnancy and after birth can cause lots of changes to your body. Some
of these changes will be to your breasts as your body is preparing to feed your
baby.
This leaflet identifies the main
breast changes you may experience during pregnancy, but it also highlights the
importance of continuing to be “breast aware” in the future.
Being “breast aware” is about becoming
familiar with your breasts and how they may change throughout your life. It
means knowing how your breasts look and feel normally so that you feel
confident about noticing any changes that may be unusual for you. Sometimes,
this may be more difficult during pregnancy because of normal changes that
occur to the breasts at this time.
If you are unsure about any changes to
your breasts, it is advised that you discuss your concerns with your midwife or
GP.
The breasts and nipples
The breasts are mainly made up of fatty tissue that starts
high on the front of the chest and continues down and around into the armpit.
They are supported by ligaments and the large chest muscle.
Each breast contains a number of lobules
made up of milk-producing cells and ducts, surrounded by glandular, fibrous, and
fatty tissue. Each lobule has a main duct that opens onto the nipple.
The darker area of skin around the
nipple is called the areola. On the areola, you may notice, there are some
small raised bumps called Montgomery’s Tubercles, which produce fluid to
moisturize the nipple.
Each breast contains a number of
lobules made up of milk-producing cells and ducts, surrounded by glandular,
fibrous, and fatty tissue. Each lobule has a main duct that opens onto the
nipple.
How do breasts change
during pregnancy?
Changes to your breasts are usually
one of the early signs that you are pregnant. These changes may include the
following:
·
tenderness or a change in sensation of the
nipple and breast - this is caused by increased levels of the
hormone progesterone and the development of the milk ducts
·
an increase in breast size or a change of shape
-
this varies from woman to woman. You may notice a big change in the
size of your breasts or very little change at all. The breast tissue extends
into the armpit. Some women have additional breast tissue (accessory breast
tissue) under the arm and this may also get bigger. An increase in size may make
your breasts feel heavy and/or tender
·
changes in color and size of nipples and
areola - as the pregnancy progresses the nipples and
areola usually become darker in color, and the Montgomery’s Tubercles may
become bigger and more noticeable
·
more
prominent veins on the surface of the breasts
From about the 16th week of
pregnancy the breasts are able to produce milk. It’s not unusual for small
amounts of clear or colored fluid called colostrum to leak from the nipples.
This is normal and not something that you need to be concerned about.
Colostrum is often referred to as the
“first milk” and is full of nutrients and antibodies designed to provide your
baby with additional protection during the first few days after the birth. If
you are worried that it may be noticeable on your clothes, you can use a breast
pad (a disposable or washable fabric pad) inside your bra. You can also speak
to your midwife about collecting the colostrum during your pregnancy to give to
your baby after he/she is born. Your midwife will be able to advise you on
when/how to do this safely.
A few women may notice occasional
leakage of blood from their nipples. This can be caused by the increased number
and sudden growth of blood vessels. Although this can be normal during pregnancy,
it is always advisable to get any leakage of blood from the nipple checked by
your midwife or GP.
In the last few weeks of pregnancy, your nipples may become larger and the breasts continue to grow as the
milk-producing cells get bigger. This may cause your breasts to feel tender and
sensitive. Wearing a well-fitting bra may help relieve any discomfort and its
fine to sleep in your bra if it is more comfortable for you.
Breast
lumps sometimes develop during pregnancy. The most common ones are:
•
Cysts (fluid-filled sacs)
•
galactoceles (milk-filled cysts)
•
fibroadenomas (which develop in the
lobules of the breast). These are benign (not cancer) breast
conditions. If you had a fibroadenoma before you were pregnant you may find
this gets bigger during pregnancy
Most breast lumps that develop in
pregnancy are benign. Breast cancer in women of child-bearing age and during
pregnancy is uncommon. However, you should get any new breast lump checked by
your GP. If you already have a breast lump that has been diagnosed as a cyst or
fibroadenoma, for example, tell your GP or midwife and let them know if it
changes.
Bras
As
your breasts increase in size you should check that your bra isn’t too tight.
A
bra fits well if:
•
your breasts fill the cup of the bra leaving no loose fabric
and it contains the whole breast without any bulging at the top, bottom or
sides
•
the strap
at the back doesn’t cut in
•
the shoulder straps don’t carry the full weight of your
breasts, stay in place when you lift your arms above your head and fit closely
to your body without digging in
•
the strap around the back and the front underband (gore)lies
close to your body and are at the same level at the front and back
•
with an underwired bra, the underwire lies flat against your
body and supports the underneath and sides of your breast without digging in or
gaping
It’s sometimes suggested that pregnant women shouldn’t
wear underwired bras as the wiring may cause blockages in the milk ducts. There
is no evidence to support this and as long as the bra fits you well and the
wires of the bra aren’t digging in, there’s no reason to stop wearing an
underwired bra. However, you may find it more comfortable to wear a maternity
or soft cup bra. These types of bras can also be worn in bed if you feel you
need extra support while sleeping.
If you’re hoping to breastfeed, you
may want to buy a couple of nursing bras. These have cups that unhook or unzip
and make it easier to feed your baby. The best time to be fitted for a nursing
bra is a few weeks before your baby is due when your breasts will have done the
majority of their growing. If you go to a department store or lingerie shop to
be fitted for your nursing bra the fitter should take into account that your
breasts will increase in size when you start producing milk, but will probably
settle down again later. The fitter will probably suggest going up one or two
cup sizes to allow for this.
Following the birth of your baby,
estrogen and progesterone levels decrease quickly. Around the third day or so
after the birth the colostrum changes to include additional fluid that makes it
look much whiter. Around this time your breasts may start to leak milk.
When a baby sucks at the breast it
triggers nerves that carry messages to the brain that milk is needed. A hormone
called oxytocin is released from the brain and milk is sent to the ducts behind
the nipple. You may hear this called the 'let down' reflex. It can be very powerful,
and some women find milk leaks from the nipple when they hear their baby cry,
or if their breasts are full and they feel emotional.
Breastfeeding
The changes that happen to your breasts during
pregnancy prepare them for feeding a baby. Whether or not you breastfeed is
your decision and some women simply don’t feel it is the right choice for them
and their baby. There isn’t a right or wrong decision; you just need to feel
you have made the best decision for you and your baby.
Women who have had previous breast
surgery - due to breast cancer or breast augmentation, occasionally find
breastfeeding a little bit more challenging. Many women are still able to
breastfeed after their surgery, depending on the type of surgery they have had.
You can contact the Infant Feeding Team for support and/or information.
Possible breast problems after pregnancy
The following information describes
some of the problems you may experience when your milk ‘comes in’ (when your
body begins to produce breastmilk and no longer colostrum). This information
may apply whether you decide to breastfeed or not.
Sore and cracked nipples
Sore and cracked nipples can develop
if the baby does not attach to the breast correctly. If the baby has a shallow
latch, or if the baby’s tongue or roof of the mouth rubs on the nipple. The
nipples can quickly become sore and sometimes cracked. It’s important to ask
for support and advice from a midwife or the Infant Feeding Team as soon as
possible if feeding is painful for you. The nipples won’t heal if the baby
doesn’t attach to the breast properly.
Breast engorgement is when the
breasts become overfull of milk. It can happen if the baby removes less milk
from the breast than the amount that you are producing. Some women may describe
their breasts as feeling hard, warm, and throbbing. Breast engorgement generally
happens when the milk first comes into the breasts (around about day 3 after your
baby is born). It may also happen if your baby is not feeding frequently
enough, if the breasts are not emptied sufficiently or if the baby is having
difficulty attaching to the breast. It can happen if you’ve decided not to
breastfeed at all, or if you suddenly stop breastfeeding.
If your breasts are engorged and you
are continuing to breastfeed, it’s important to make sure your baby is
attaching to the breast correctly. The Infant Feeding Team or your healthcare
professional can help you with this.
Breast
engorgement may be eased by:
•
feeding
your baby responsively
•
expressing to release a small amount of milk either by hand
or using a pump, so it’s easier for your baby to attach to your breast
You
may also find the following helpful:
•
wear a well-fitting nursing bra that doesn’t restrict your breasts.
•
apply warm or cold compresses to your breasts before
expressing your milk. This may help to reduce pain and swelling
•
take paracetamol at the recommended dose to ease the pain.
This is safe to take while you are breastfeeding.
Blocked milk ducts
Sometimes a milk duct becomes
blocked. You may notice a small, painful, hard lump or a bruised feeling.
Things
that may help include:
•
feeding
your baby more often
•
changing
position when you’re feeding (this may help to drain the area more fully)
•
gently
massaging the lump towards the nipple while your baby is feeding
•
applying
warm flannels to the breast
•
ensuring
your bra and clothes aren’t too tight so the milk can flow freely
Mastitis occurs if breast engorgement or blocked milk
ducts continue, and the breast(s) become inflamed or infected. The breast may
appear to be red and feel hot and painful. Mastitis can cause flu-like symptoms
including headache, nausea, and a raised temperature. If you think you may have
mastitis you’ll need to see your doctor as it may need treating with
antibiotics and/or anti-inflammatory drugs. Mastitis can also occur if you have
chosen not to breastfeed.
If you are breastfeeding it is
important to continue to feed your baby frequently as this helps to clear the
infection and is not harmful to the baby, as any bacteria are killed in the
baby’s stomach.
Putting a warm flannel on the breast
or having a warm bath or shower before you feed your baby can help the milk to
flow. If your breast is not sufficiently drained after feeding, you may be
advised to express some of the remaining milk either by hand or using a breast
pump to relieve your discomfort.
Breast abscess
If mastitis or an infection isn’t
treated, some women go on to develop an abscess (a collection of pus) in the
breast. Breast abscesses are not common - if you think you have an abscess it
is very important to see your midwife, your GP or speak to the Infant Feeding
Team. They may refer you to the breast clinic at your local hospital.
Thrush
Thrush (candida albicans) is a yeast
infection that can occur on the nipple and areola. It can develop if there is
any damage/trauma to the nipple. It can also happen suddenly without any
obvious nipple damage, even when you’ve been breastfeeding for some time.
The nipple may become itchy, painful, and sensitive to touch. Some women find they have shooting pains deep in the
breast that start after feeding and can last for a few hours. If the pain is
particularly severe it may mean the infection has extended into the milk ducts.
Sometimes thrush can be difficult to
diagnose as the symptoms are similar to those caused by the baby not being
latched onto the breast properly.
Thrush can also be passed from mother
to baby. Signs of thrush in your baby may include a creamy patch on the tongue
or in the mouth that does not rub off, restlessness during feeding, pulling
away from the breast, and nappy rash (red rash or soreness that is slow to
heal). Both you and your baby will need to have treatment at the same time.
What happens if I don’t breastfeed, or want to
stop?
If you choose not
to breastfeed and no milk is being expressed you will stop producing milk. You
may find your breasts feel engorged (heavy, uncomfortable, and tender) for a few
days. Wearing a supportive bra and taking pain relief may help.
If you are breastfeeding you will
continue to produce milk as long as breastfeeding continues. When you stop
breastfeeding it may take some time for the milk production to stop completely.
If you stop breastfeeding suddenly,
this can lead to engorgement so it is best to gradually reduce the length and
number of your breastfeeds. When you stop breastfeeding, your breasts will
gradually reduce in size.
Your breasts after pregnancy
After pregnancy, whether you have
breastfed or not, your breasts probably won’t look or feel the same as they
used to.
You may have gained or lost weight.
It is not unusual to find your breasts have altered in size and shape compared
with before pregnancy.
These changes are part of the normal
changes your breasts go through at different stages in life. It is important
that you get to know how your breasts look and feel now, so you can be aware of
any new changes.