Breast Self-Exam, 
Even When Pregnant or Breastfeeding

 By Debbie Albert, Ph.D., IBCLC 

  Nursing a baby tends to be a miraculous time in our lives.  Very rarely do we want to take the time to focus on ourselves, but there are many plusses to continuing monthly, breast self-exams while pregnant or during lactation.  Self-exam can assist in the breastfeeding process, as well as keep you healthy and safe.  Believe it or not, breast cancer occurs in one out of every 3,000 pregnancies, so it’s worth it to continue this monthly practice even though you may not have a menstrual period to remind you.  If you are breastfeeding, just make sure that you have fed the baby or pumped prior to doing a breast self-exam.

 First, stand in front of a mirror naked from the waist up.  If both breasts are normally the same size, and one is larger--perhaps you need to feed on the larger breast first next time.  Also, take a look at your nipple tips.  If they are very pink or dry/scabby, baby is probably nursing too much on your nipple tip or you may be developing a yeast infection.  Try to get the baby to take as much of the breast as possible during feeds.  Make sure the baby's mouth opens wide (tongue down) and you are placing the baby firmly on as much areolar tissue as possible. If the soreness persists, please see a lactation consultant.  Lean over, and look at your breasts.  It is important to look for dimpled or lumpy areas.

 During pregnancy and lactation, your breast tissue will be more dense.  Dr. Amie Jew of Menorah Medical Center strongly recommends breast self-exam, even though breasts are swollen and tender. She claims that it is like feeling for a "pit" in a peach [From videotape: Breast Self-Exam During Pregnancy and Lactation (2000) Health Midwest]

 If you do regular self-exam, try to look for changes that are occurring on one breast as opposed to changes that appear to be taking place in both breasts.  The best position to do circular motions around the breast is while lying down on your back.  Take your hand and press into your breasts in a circular pattern with your fingertips.  Make sure you start at the collarbone and go completely around both breasts and under your armpit.  Feel for any lumps or tenderness.  A majority of the time, a lump is a plugged duct.  Try frequent massage and heat before feeds with ice packs afterwards.   Once you notice a lump, try to feed baby on that breast first for the next two or three feeds.  Try to get the baby's nose or chin to point directly toward the lump. 

 Sometimes a tedious plugged duct can become mastitis or breast infection.  Typical signs of breast infection include red breast tissue, maternal fever, and flu-like symptoms (lethargy and achy joints).  Sometimes moms confuse breast infection symptoms with thrush or a yeast infection.  Thrush symptoms include itchy nipples, sharp shooting pains in the breast between feeds, shimmery nipples or the development of a yellow or white color cast on the nipple.

 If a lump persists for over a week despite all efforts, if you suspect a breast or yeast infection, if you notice any unusual scaliness or rash on the breast tissue, or if there is unusual breast discharge, please see your physician promptly.  It is possible to have a mammogram during lactation.  Just make sure you nurse the baby or pump immediately prior to the exam.         

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