Hello everybody.  I want to share a case.  A G3P3 mother in her mid-30's
with a nursing 8 mo old came to see me last week with a plum size mass in
her left breast superior to the nipple at 12:00.  She became aware of the
lump in Aug. when she discovered a {"grape size" mass while handling her
breast.  She saw a family practice doctor who eventually sent her to a
breast surgeon. There was no fever or typical mastitis sx and no antibiotic
therapy was ever used.  The FP doc told her to exclusively pump for 2 weeks.
She used cheap semi-auto. pump for 5 days then quit because breast couldnt
drain. The surgeon used mammagraphy and ultrasound to visualize a solid
lesion.  5 days prior to my visit with her (near the end of Sept.) there was
fine needle aspiration of contents of mass which surgeon stated were
"benign"  yet by now mass is size of plum.  He told her that he couldn't
biopsy a lactating breast and that she should wean.  No sense of urgency
about this was communicated to mother -- more like lets wait and see if it
goes away once you wean.  He commented that it might still need to come out
if it didn't go away once weaned.  She sought my opinion on the weaning.  I
told her that even popular press books like Susan Love's Breast Book
discussed doing biopsy during lactation (gave her copy to see) and told her
she had a situation that required a more informed second medical opinion.  I
felt the mass which seem fixed, ragged around edges with "fingers".  I did
not observe peu d'orange or induration.  Infant was willing to nurse on the
breast.  There was significant bruising from the repeated needle sticks (5)
done during the aspiration.  I told her to wean abruptly might place her at
increased risk for additional problems like abscess.  I urged her to see
more knowledgable surgeon asap.  She phoned the surgeon I recommended who
was kind enough to see her within 24 hrs.  Within 24 of hrs of that visit
she was in hospt. for biopsy.  I got a message yesterday after returning
home from lecture at the MANA conf. (Midwives) that she had left word at my
office that the mass is malignant.

I am heartsick for this mother and her three little children.  We must
continue to teach in our communities that unexplained masses in the breast
of ANY woman whether she is preg. or lactating MUST be closely investigated.
If they don't resolve with usual, conservative methods and can't be clearly
identified as benign, they must be biospsied.  There is too much at risk to
delay on the grounds that it is probably related to lactation and will just
"go away."  That is denial!!  This mother may pay with her life.
Barbara