Lumps, discomfort, and pain during breastfeeding are common and often harmless, but experts caution that certain warning signs should not be ignored. Dr. Keerti Khetan, Director of Obstetrics & Gynaecology at CK Birla Hospital, Delhi, explains when these symptoms require medical evaluation, why younger women are increasingly reporting breast abnormalities, and how to differentiate benign conditions like mastitis or blocked ducts from more serious concerns.
Q. Lumps and pain are common during breastfeeding. At what point should a woman consider getting screened or seeking further diagnostic evaluation?
A: Lumps and discomfort during breastfeeding are fairly common and often result from benign causes such as engorgement, blocked milk ducts, or mastitis. In most cases, these issues can be resolved with simple measures like frequent breastfeeding, warm compresses, and gentle massage.
However, certain warning signs should prompt a woman to seek further medical evaluation. If a lump does not resolve within one to two weeks, even if it is painless, or if it keeps recurring in the same area, it may indicate a chronic blockage or a benign cyst that requires attention. Persistent fever lasting more than 24–48 hours may suggest progression to a breast abscess, especially if accompanied by a localized, painful, or fluidfilled lump.
Other concerning signs include unusual nipple discharge, especially if it's bloody or green, skin changes such as dimpling, puckering, or an “orange peel” texture, and unexplained nipple inversion or cracks that do not heal. A personal or family history of breast cancer also warrants more caution. In such cases, a clinical breast examination followed by imaging like an ultrasound, which is safe during lactation, and possibly a mammogram or biopsy, may be recommended. Timely evaluation is essential to rule out serious conditions, including breast abscesses or, in rare cases, breast cancer.
Q. Are you seeing a trend of younger women presenting with breast abnormalities? What could be driving this shift?
A: Yes, there is a growing trend of younger women, including those under 40, presenting with breast abnormalities such as lumps, discomfort, and other changes. Several factors appear to be contributing to this shift. First, increased awareness about breast health and improved access to healthcare have led more women to seek early evaluation for any concerns, resulting in earlier detection of both benign and serious conditions. Lifestyle changes, such as delayed childbearing, shorter durations of breastfeeding, and the more frequent use of hormonal contraceptives, may also influence breast tissue development and susceptibility to issues.
In addition, environmental and hormonal factors, including obesity, high-fat diets, exposure to endocrine-disrupting chemicals, and sedentary habits, are known to affect breast health. Genetics also play a role, with a family history of breast conditions often leading to earlier manifestations in younger women. Notably, benign conditions like fibroadenomas and galactoceles are more common among younger age groups and are now being diagnosed more often due to increased screening. This trend highlights the need for targeted awareness campaigns, early screening opportunities, and support systems for young women dealing with breast health issues.
Q. Can you explain how conditions like mastitis, blocked ducts, or galactoceles are diagnosed, and how women can differentiate them from more serious breast issues?
A: Breastfeeding-related conditions like mastitis, blocked ducts, and galactoceles are typically benign and manageable, but recognizing their symptoms and differentiating them from more serious conditions is vital for timely intervention. Mastitis is caused by inflammation, often due to infection, and presents with symptoms like breast pain, swelling, redness, warmth, and systemic signs such as fever and flu-like symptoms.
Diagnosis is usually clinical, but if symptoms persist beyond 48 hours or if a breast abscess is suspected, an ultrasound may be recommended. Blocked or clogged milk ducts result from milk flow obstruction and typically present as localized, tender lumps with mild redness, but without fever.
These often resolve within 24–48 hours with measures like regular breastfeeding and gentle massage. Galactoceles are milk-filled cysts that arise from ductal blockages, commonly appearing during or after weaning. They are generally painless, soft, and movable, and are confirmed through ultrasound. In some cases, they may require needle aspiration if persistent or uncomfortable.
However, certain signs suggest a need for more urgent evaluation. These include lumps that persist for more than two weeks, changes in the skin such as dimpling or a thickened “orange peel” texture, unusual or bloody nipple discharge, newly inverted nipples, and systemic symptoms like fever or chills that do not improve with treatment. In such cases, imaging studies like ultrasound or mammograms, and possibly a biopsy, are necessary to rule out conditions such as breast abscesses or malignancy. Educating women on what to expect during breastfeeding and when to seek help empowers them to seek timely care and ensure the best outcomes for their health.
