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.