Trying to decide about breast surgery while breastfeeding your thoughts?

[soccerchic21]

Ok I have an avacado sized lump in my left breast. I noticed it in June. I had a core byopsy done a few weeks ago that showed the cells they tested as being benign GREAT NEWS!!! I am breastfeeding a 3 month old and a 2 year old.

However

Everyone I speak to recommends taking it out because of the size.

I met with a very breastfeeding friendly surgeon yesterday and he would like to see it gone. Basically everyone is worried about how fast it is growing. So he said he can't take it out if I am lactating in that breast.

Here are my options.

1) Stop nursing on my left side. Let it go dry and continue to just nurse on the right side. He said it would take about 3 weeks. Then he can take the lump out of the left side.

2) I can decide to not do anything now and wait until I wean my son or until he is getting solids but then I would need to go in for monthy mammograms to watch the growth of this lump.

3) and of course wean completely (yeah right!)

So I have some concerns of course. I JUST got a full-time job and put notice in at my old job my last day is Friday. So on Monday I start working and pumping for my 3 month old full-time. I am worried about going to just one breast and making enough milk for him. What I do have going for me is that the lump is in my low producing side anyway.

I could wait until he is taking solids but then I have to go in for monthy mammograms which could be costly as well.

I am sort of leaning toward just weaning to one side and taking the thing out now and getting it over with. But my baby has not had a drop of formula and he is a 17lb 3 month old and I am so proud of that. Then again I am telling myself that if I did "need" to supplement it would probably be just a little and for a short time until my right breast caught up.

I needed some Lactivist advice. What do you all think?

[TigerTail]

tandeming with one of the babies being three months old, that is tough.

i am left-breasted unlike you though, & honestly if it was me i would wean from the one poor producer if i was uncomfortable waiting (and an avocado-sized lump sounds uncomfortable; i'm thinking 'hass or fuerte?'), & certainly before weaning entirely- at 3 months! i'd have to be in active chemo for that.

i have to wonder how 'lactating' he means by 'not lactating' though; i had milk i could squeeze out 14 years after my dd was born. boobs that work well don't completely give up function quickly & easily, kwim? (i imagine he means something reasonable, like the state of my breasts with a 3 and 4 yr old that only nurse at night, and no real discomfort if i skip some.)

i wish you luck. what a hard decision. susan

[sntm]

It's not exactly true that he can't take it out while you are lactating. There is a higher risk of milk fistula (where the milk ducts leak into the wound).

How deep is the mass? Is it superficial or deep? Is it visible by ultrasound? If so, they could use U/S to follow the size instead of mammography. How long has it been followed? What has the size change been so far? Do you know the exact pathology results or just that it was "benign"? Is your surgeon specifically a fellowship-trained breast surgeon or a general surgeon who does breast surgery?

There are a lot of different options here and different considerations. I've got about a dozen other questions I would ask you as well. If you want to PM me I can give you my input. Keep in mind, I'm a general surgery resident, planning on doing a breast surgery fellowship but not boarded yet. Still, breast masses during lactation are an interest of mine, so I'm motivated to help search down some data for you.

If you interested PM me and we can go into specifics.

[alegna]

As long as you're still nursing (on the other side) that side will still make milk.

-Angela

[fromscatteredtribe]

not the same, but i had an abcess and was pregnant and breastfeeding and they were able to remove the abcess surgically. they even had to leave a golf ball size hole in my breast and i had to stuff it with gauze soaked in saline changing the drezssing every 12 hours for two weeks. i was able to continue nursing without a problem the breast surgeon did not love it and mentioned weaning and giving my boobs a break about 50 times, but she COULD operate just fine. good luck with your decision. so sorry that you have to deal with that

[Plummeting]

I would be absolutely uncomfortable having monthly mammograms for any amount of time. Think of all the radiation. I know they say x-rays are safe, but there is a point you reach when the cumulative effects become dangerous. It seems to me that monthly mammograms could *cause* cancer. JMHO.

[soccerchic21]

Originally Posted by sntm

It's not exactly true that he can't take it out while you are lactating. There is a higher risk of milk fistula (where the milk ducts leak into the wound).

Yes he brought that up. I think that is one of the main concerns plus he mentioned having milk leak into the wound could cause healing issues.

How deep is the mass? Is it superficial or deep? Is it visible by ultrasound? If so, they could use U/S to follow the size instead of mammography. How long has it been followed? What has the size change been so far? Do you know the exact pathology results or just that it was "benign"? Is your surgeon specifically a fellowship-trained breast surgeon or a general surgeon who does breast surgery?

The top of the mass is close to 12:00 on the surface of my breast but then it goes deep into my breast. Picture the tip of the avacado at the 12:00 station then the rest of it buried into my breast. So it is deep.

Yes you can see it by ultrasound. It measures 7cm by 5cm I believe.

We are not sure about the size change as I have only had the one ultrasound, mammogram and core byopsy done last month.

I did see the pathology results and there were no abnormal cells. They are just calling it a "lactating adinoma"

Yes I saw a fellowship trained breast surgeon.

There are a lot of different options here and different considerations. I've got about a dozen other questions I would ask you as well. If you want to PM me I can give you my input. Keep in mind, I'm a general surgery resident, planning on doing a breast surgery fellowship but not boarded yet. Still, breast masses during lactation are an interest of mine, so I'm motivated to help search down some data for you.

If you wouldn't mind I would love you to post your questions and input here for other women to see.

[soccerchic21]

Originally Posted by Plummeting

I would be absolutely uncomfortable having monthly mammograms for any amount of time. Think of all the radiation. I know they say x-rays are safe, but there is a point you reach when the cumulative effects become dangerous. It seems to me that monthly mammograms could *cause* cancer. JMHO.

That is what worries me too. I feel like I need to choose the lesser of two evils. I am leaning more toward just doing the surgery. I do have a good milk supply right now and my right side has always produced more milk anyway.

[JuniperMama]

My DS rejected my left side completely when he was 5 months so I had to nurse one sided. I pumped both sides for a while but eventually decided to just let the left go. Haven't pumped left since July and it does not produce any more - I can squeeze just a couple drops out if I work it but otherwise its not producing.

I really do think that you can continue to at least nurse the baby on one side. I did it/am doing it with virtually no supplementation (literally maybe 8oz. of formula in his whole life). It will take a bit for the right to catch up but it will. If you can pump the right side after every time you nurse it will help that side kick up its production.

HTH,
Jenn

[soccerchic21]

Originally Posted by JuniperMama

I really do think that you can continue to at least nurse the baby on one side. I did it/am doing it with virtually no supplementation (literally maybe 8oz. of formula in his whole life). It will take a bit for the right to catch up but it will. If you can pump the right side after every time you nurse it will help that side kick up its production.

HTH,
Jenn

YES! That is so helpful. I was hoping there would be someone here who had nursed on just one side. Thank you!

[sntm]

If it is visible by ultrasound they could follow it that way. They could also evaluate it with MRI, though that is expensive and insurance doesn't always cover it.

The reason for removing a benign mass is that the core biopsy obviously only samples a small portion and cannot rule out that there is a cancer in other portions of the mass. That said, there are algorithms to work out what your actual risk is, based upon your current age, age at first period, age at first live birth, number of relatives with breast cancer and when they were diagnosed and whether they were first or second degree relatives, and any previous history of breast biopsy. If your risk is low, I would say that there is no problem with following it clinically. We usually evaluate size change after 6 weeks, so a repeat ultrasound could detect any size change.

If you chose to undergo surgery, you could clearly inform the surgeon that you are aware of the risk of milk fistula and accept that risk. If he is willing to, he can just document it clearly that he advised weaning and you chose not to with full awareness of the risks. Since this is an adenoma, he would not be taking wide margins (unless it looked highly suspicious intraoperatively) so it would likely be just shelling out the benign tumor, with lower risk than performing a lumpectomy where you are cutting through normal tissue.

Milk itself is not harmful to the wound, and is actually bacteriostatic, so in and of itself would not cause wound infections. the wound may take longer to heal because of the drainage, and you may have to have an open wound versus a closed wound (or a drain placed within the cavity which could be removed if there was no leakage. Or he could try closing it and just plan to open the incision if a fluid collection developed.

Weaning from either breast is highly unlikely to eliminate milk production in just 3 weeks. It often takes months. So, all it would be doing is reducing the milk production. this in and of itself may not be that big of a deal. You could allow that breast to involute a little over the 3 weeks he specified, nursing and pumping off the other breast. Following surgery, you could start pumping and nursing on that side again and try to regain your supply there. Removal of the tumor may even allow better supply there, particularly if he is careful to avoid transecting the milk ducts. I actually have a theory, as yet to be tested as I am only a lowly resident and don't get to make these decisions, that if dissection is performed only in a radial fashion (along lines like spokes in a wheel) that less damage will occur and milk production capabilities afterwards will be better preserved. The skin incision could still be along the skin lines (usually curved to follow the contour of the breast).

Incidentally, the radiation exposure from mammogram is actually quite small. The risk-benefit is definitely on the side of having them, as they save tens of thousands of lives. The main reason for suggesting ultrasound is that it would be nice to avoid it if possible, ultrasound can be better for dense breasts like those in younger women and lactating women, and it's less discomfort.

One thing I didn't mention before is also to make sure your radiologist is experienced in breast imaging, preferably in that this is all s/he does or has had breast imaging fellowship training. Also, make sure that s/he knew that you were lactating, as that can impact his/her interpretation.

Hope that helped! If you would like me to calculate your personal risk, let me know your specifics or you can try to google "Gail Model" and see if there is an online calculator.

[FrumDoula]

Originally Posted by soccerchic21

YES! That is so helpful. I was hoping there would be someone here who had nursed on just one side. Thank you!

I nursed off my left breast exclusively for almost 4 years. It can definitely be done! I chose to nurse off both breasts for kiddo #2, and that has been a wonderful experience, too. I have no regrets about nursing off one side, except that I looked a but lopsided.

[Ruthla]

I would get a second opinion, and find out if the lump can be removed without weaning.

Second choice would be to get monthly sonograms (are the cancer-causing x-rays REALLY required to monitor this?) for a few months and wean from Lefty once you've settled into the new job and you're sure you can pump enough- possibly waiting until the little one's on solids before weaning to one side.

It's certainly possible to get enough milk from one side only- look at how many mamas nurse twins or triplets! The only issue might be the transition period- you might have a few days or weeks before your right side "catches up" to producing what the left side used to make. This can be minimized by favoring the right side and weaning slowly from the left side- I'd suggest getting the babies to nurse exclusively from the right side before you stop pumping from the left side, since pumping output is your primary concern, and pumping tends to be less effective at stimulating supply than nursing is.

[numom499]

I know it is possible to nurse from just one side. LLL always mentions this group, in China i think, that, for cultural reasons, only nurses on one side. I just tried googling it and couldn't find anything quickly. MAybe someone else has a link... I do know that they were found to only get breast cancer in the side they didn't nurse on

Would you try to go back to nursing after the surgery? If you are only gonig to nurse on one side (temporarily or not) I would switch poistions frequently, ie. the football hold, the cradle hold, etc...so that he gets visual stimulation for both eyes and also if you decide to go back to nursing on the other side, he is used to different positions. Good luck.

[mama24-7]

There was a story in Mothering magazine, I think less than 1 year ago, about a mother who nursed twins off of one breast. The breast she didn't use had been badly burned years earlier and after exploring reconstructive surgery to possibly repair the breast (they have her a 10% chance of being able to nurse on that side and that was if the wound would stay open, if my memory serves me correctly) she decided to just use the one breast. The story made no mention of supplementation so I don't think she did.

With that said, I'd say just nurse on the one side. I think you will be fine.

Good luck,
Sus

[soccerchic21]

Originally Posted by numom499

I know it is possible to nurse from just one side. LLL always mentions this group, in China i think, that, for cultural reasons, only nurses on one side. I just tried googling it and couldn't find anything quickly. MAybe someone else has a link... I do know that they were found to only get breast cancer in the side they didn't nurse on

My friend was just telling me about this it is a Japanese culture that does this. I don't know of the name though.

Would you try to go back to nursing after the surgery? If you are only gonig to nurse on one side (temporarily or not) I would switch poistions frequently, ie. the football hold, the cradle hold, etc...so that he gets visual stimulation for both eyes and also if you decide to go back to nursing on the other side, he is used to different positions. Good luck

Yes I would definitely try to nurse on the side that was operated on as soon as I could. I do not plan on weaning completely if I get this done. Thank you for the advice about position changes I forgot about that.

[roamingfamily]

Originally Posted by mama24-7

There was a story in Mothering magazine, I think less than 1 year ago, about a mother who nursed twins off of one breast. The breast she didn't use had been badly burned years earlier and after exploring reconstructive surgery to possibly repair the breast (they have her a 10% chance of being able to nurse on that side and that was if the wound would stay open, if my memory serves me correctly) she decided to just use the one breast. The story made no mention of supplementation so I don't think she did.

With that said, I'd say just nurse on the one side. I think you will be fine.

Good luck,
Sus

That story is currently on the Mothering home page. It's a beautiful article. Not only did she nurse twins, she tandemmed with one breast before the twins were born.

[treehugginhippie]

Reviving this thread. I'm having my lactating adenoma removed on Monday and looking for feedback: . Dd is no longer nursing (for 5 mo now). But I'm very concerned about nursing a future baby.

soccerchic21- How was the incision made? Was it across the ducts or along the same direction (cutting less ducts)? Did your ducts regenerate? Did you have full function again?

Thanks in advance

[mamajake]

Originally Posted by treehugginhippie

Reviving this thread. I'm having my lactating adenoma removed on Monday and looking for feedback: . Dd is no longer nursing (for 5 mo now). But I'm very concerned about nursing a future baby.

soccerchic21- How was the incision made? Was it across the ducts or along the same direction (cutting less ducts)? Did your ducts regenerate? Did you have full function again?

Thanks in advance

Check in at http://www.bfar.org . There isn't anything they don't know about breastfeeding after breast surgery.

[pixiesmommy]

Just chiming in to say that I am also a one-breast nurser My DD was always fussy at my left breast and we gave it up when she was less than a year old, though I was a work-outside-the-home mom from the time she was 3 weeks old, so I did continue to pump both breasts until she was about 14 months old.

I nursed her successfully from about 9 months til 3.5 yrs on my right breast. It IS possible and you will look lopsided, but you'll increase supply on that side to meet the demand.

Hope it goes well for you.
Manda