Dear Joy,

Here are few thoughts about the mother with a persistent breast cyst.

The patients I have seen with galactocoeles can note some tenderness but
this is usually mild.   The galactocoeles also tend to decrease in size with
nursing. There is no overlying redness.  I have mothers express after every
feeding to keep the duct as empty as possible.  I explain that the duct is
like an elastic band.  If you keep it empty it is more likely to come down
in size than if it remains taught or partially expanded.  All of the ones I
have seen have settled well.

You should also rule out adenitis (infection within the duct).  This would
certainly account for the pain.  If the lump has any overlying redness it is
very likely to be adenitis. The physician could also try to culture the milk
(s)he aspirates from the cyst.  For adenitis, the patient would use
antibiotics and expression of the duct after every feed.  I had one case
that was very persistent - she needed one course of cephalothin and two of
clindamycin.  The patient did fine after that.

This could also be a partially plugged duct associated with a milk bleb
(milk pimple on the anterior surface of the nipple).  Once you open the bleb
with a small needle, the duct is able to empty well and there are no further
problems.

As always you have to worry about breast cancer causing an obstruction but
this is certainly not the first diagnosis to go to.  This is a tough one to
diagnose as mammograms are virtually useless in breastfeeding women.  The
tissue is so dense it causes a white-out.  (Like the weather has been up here!)

Hope this helps, from the brisk Great North (-35 C tonight),

Shirley



M. Shirley Gross M.D.,C.M., C.C.F.P., I.B.C.L.C.
Director, Edmonton Breastfeeding Clinic
Edmonton, Alberta, Canada
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