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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