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From:
Pamela Morrison <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 24 Sep 2012 10:48:47 +0100
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Fleur

Could this be Mondor's disease?  Years ago I had 
a client with what looked like a very prominent 
vein, palpable just under the skin running from 
roughly where the breast joined the centre of the 
chest wall, across her breast to the nipple.  It 
was raised and a bit inflamed and itchy, and she 
was naturally worried about it. It had been 
diagnosed as Mondor's and she told me that it 
became so enlarged while breastfeeding her last 
baby six years previously that the skin had split 
- naturally she wanted to avoid a repeat.  My 
medical dictionary described Mondor's as 
"inflammation of large subcutaneous vein crossing 
the lateral chest region and breast, the vessel appearing as a tender cord."

If you're able to get hold of back issues, 
Breastfeeding Review May 1993, p 348 contains a 
good description of what this is, when it happens, presentation.

Then googling, I found these descriptions:
http://www.ajronline.org/content/177/4/893.full
Mondor's disease of the breast is a rare benign 
breast condition characterized by 
thrombophelebitis of the superficial veins of the 
chest wall. This condition is rarely reported, 
which, in part, may be due to lack of awarness of 
the entity. Little has been written about the 
imaging findings in patients with Mondor's 
disease. A search of the literature showed a 
single published study—a case report that 
described the mammographic findings in patients 
with this condition [1]. An understanding of the 
pathophysiology, clinical presentation, and the 
imaging findings is important for the breast 
imager. Patients usually present with a painful 
breast mass, and, although Mondor's disease is 
usually a benign, self-limiting condition, 
imaging is recommended primarily for the 
evaluation of the palpable mass. An association 
with breast cancer has been reported [2].

<https://www.researchgate.net/publication/221873320_Mondor's_disease_of_the_breast._A_retrospective_review>https://www.researchgate.net/publication/221873320_Mondor's_disease_of_the_breast._A_retrospective_review 

Mondor's disease of the breast. A retrospective review.
Nikolaos S Salemis, Stamatios Merkouris, Konstantina Kimpouri
  Breast Cancer Surgery Unit, Army General Hospital, Athens, Greece. nikos
Breast disease 02/2012; 33(3):103-7. DOI:10.3233/BD-2012-0332
  ..... Mondor's disease of the breast is a rare 
benign self-limiting clinical entity. 
Ultrasonography is the diagnostic modality of 
choice but mammography may be inconclusive in the 
presence of dense breast tissue. Awareness of 
this rare entity is mandatory to prevent an 
unnecessary biopsy whereas the patients should be 
reassured of the benign nature of this disorder. 
Thorough evaluation is however necessary to rule 
out an underlying breast cancer or another systemic disease.

For my client, we found that keeping the breast 
well drained, especially in the first couple of 
weeks, helped to reduce any discomfort, and 
certainly there was no splitting of skin this 
time around.  As far as I recall this mom 
breastfed happily for well over a year, and everything was fine.

Could your client move the baby around so that 
neither the top jaw, nor the tongue compress the 
painful area.  And instead of pumping, could she 
rather hand express with fingers/thumb at 6 and 
12 o'clock to avoid pain and disturbance to the varicosed vein??

Hope this helps.

Pamela Morrison IBCLC
Rustington, England
--------------------------------
Date: Sun, 23 Sep 2012 19:32:28 -0400
From: Fleur Bickford <[log in to unmask]>
Subject: Varicose vein?

Need some input (PTP). This question was sent to 
me from one of my former clients:
"Baby is now 19 months - is still nursing a lot 
but in the last few days I've been having pain in 
my right nipple while nursing and pumping. I 
assumed it was a bit of trauma from toddler 
acrobatics but I realized today I can feel a 
tender, smooth, round pea-sized lump where the 
nipple meets the areola. I don't see a white 
bleb. The area looks blue through the flanges 
when I pump and seems to connect to some prominent blue veins.
Could this be a varicose vein? Will pumping make it worse?"

Any thoughts? Mom will be following up with her 
doctor, but hoping someone here might have some ideas.

Thanks,
Fleur Bickford BSc, RN, IBCLC
Ontario, Canada


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