I hope someone can give me some insight on a mom I consulted with last week.
She gave me permission to post but I am having difficulty contacting her for
follow-up so don't know how the story will end up.

She was referred to my office by a local breast surgeon.  My partner spoke
to her on the phone and mom said that she was 8 months into nursing her 5th
child with no previous problems.  She now had persistent engorgement on the
left side with decreased milk supply.  She was advised to use warm
compresses, massage, and pump or to wean.  She chose not to wean and the
other remedies were not working.  My partner advised her to use cabbage and
ice on the left while continuing to nurse on the right.  

The story didn't make any sense to me so I called the mom back and finally
connected with her several days later.  The story she told me was that she
had a lump in her breast for the past 3 months with decreased milk supply
and swelling.  She was not able to get anything out of the breast pumping
and started to develop shooting pains in the breast and that's when she was
advised to wean.  She did stop nursing and pumping on the left but continued
on the right.  She told me that now she had a lump in her breast the size of
an orange and her nipple was severely inverted.  The surgeon wanted to see
her again a month after weaning.  I asked her to come in that day for an
assessment of her breast.

The left breast was larger than the right.  No redness noted and no signs of
mastitis or abscess.  Her normally everted nipple was distorted and fixed to
the breast.  I couldn't evert the nipple and there was no nipple discharge.
There was a peau d'orange appearance to the skin on the lower inner aspect
of the breast.  The breast was slightly tender but not painful.  A large
distinct mass was palpable filling the entire breast with a smoothish
surface.  I suspected a very large galactocele and told her to return to the
surgeon immediately for possible drainage.  Lawrence says that a firm
diagnosis can be made with ultrasound because ducts and milk look the same
but a mass is distinguishable.  I didn't think it was malignant but didn't
want mom to take any chances by delaying treatment.  

I spoke to mom several days later and the surgeon wanted a repeat ultrasound
prior to follow-up, which she had done.  The US tech happened to be a friend
of hers and, even though she wasn't supposed to, told mom that no mass was
seen in any views.  Mom said she would let me know what the surgeon said but
hasn't called me back or returned messages that I left.

Here are my questions:  If a mom presented with a lump and was unable to
express milk from the breast, wouldn't that be pretty indicative that closer
follow-up was warranted?  Why would anyone think that engorgement in one
breast was normal in the 8th month of nursing?  Shouldn't a normal and
prudent IBCLC question the symptoms described and look for the source of the
problem, not just counsel a mom how to treat engorgement?  Have any of you
ever seen a galactocele that filled the entire breast?  Is peau d'orange and
nipple distortion common or only if the mass is very large?  Could the mass
be malignant even though the ultrasound indicates that it is not?  Does
inflammatory breast cancer ever appear like this without redness?  What's
the likelihood that mom can have this presumed galactocele drained
sufficiently?  Would she be able to relactate on the breast if she wanted
to?  What's the likelihood of recurrence if she continues to nurse only on
the opposite breast and with subsequent pregnancies?  If it is a
galactocele, can it be aspirated or would surgery be indicated for a mass of
this size?  What's the chance that a mass of this size would cause so much
damage in the breast that she would have problems with her next baby?  This
is a very intelligent and dedicated nursing mom and I'd like to be able to
give her as much information as I can.  Thanks in advance and I'll update
when I contact mom later this week.

 

Linda Anderegg, RNC, IBCLC, RLC in Chicago where Binti is happily nursing
her (gorilla) neonate and who saw SEVEN breastfeeding promotion billboards
in Springfield, IL this month! 


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