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Monday, May 18, 2009

Using Ultrasound to Identify Lactating Breast Problems


This week’s blog will focus on breast problems and Ultrasound technology. Identifying a breastfeeding problem is the necessary first step toward its resolution.

1. Lumps in the breast are never considered normal - even during pregnancy and lactation. They should be investigated properly - if the reason is unkown - using Ultrasound technology; in fact Ultrasound screening is now considered the first choice of methods used for investigating unknown breast lumps. Ultrasounds can differentiate between a cyst or fibroadenomas (tumors) even during lactation.

2. Breast tumors are uncommon - yet identifable - during pregnancy or lactation. Biopsy of the tumor is necessary to learn whether it is benign or malignant; ultrasound technology cannot pinpoint whether a tumor is benign or malignant.

3. Breast cancer is rare among pregnant and lactating women – the reported rates vary from 1/3000 (0.033%) women to 1/10000 (0.01%) women. Symptoms usually begin before or during pregnancy; increased mammary blood flow during pregnancy and lactation is thought to accelerate the growth of tumors that are present.

4. Galactoceles (dilated terminal ducts (ductules)) are the result of an obstruction of a milk duct- this obstruction may be due to a lesion or inflammation. Aspiration of the ductile using ultrasound guidance is both diagnostic and therapeutic.

5. Plugged ducts normally show up as a tender lump on the breast - usually it is not accompanied by redness or fever. Suspected causes include abrupt decreases in a breastfeeding baby’s feeding pattern, underwire bras, restrictive clothing or scarring due to an earlier breast surgery or infection. Recently, selective secretory immunoglobulin (SSI) A deficiency has been identified in women who have recurrent blocked ducts - further research is needed. Treatment of plugged ducts include massage of the lumpy (nodular) area and increased frequency/length of breastfeeding. Ultrasounds can be used to follow the plugged duct; needle aspiration of the plugged ducts is used when it is necessary to speed up the resolution of the problem and pain.

6. Abscesses can be identified via ultrasound; furthermore, ultrasounds are frequently used to help guide physicians drain abscesses, and for followup after breast procedures. Abscesses rarely (3%) occur after a bout with mastitis.

7. Breast Engorgement normally occurs within 2 – 5 days after giving birth. The treatments to be used to alleviate engorgement include cold compresses and frequent breastfeeding. Severe engorgement may compromise a mother’s milk supply by causing nipple trauma or mastitis.

8. Mastitis is an inflammation of the breast; an infectious case of mastitis can occur due to the entry of pathogens including staph, strep or e-coli or it can be the result of a non-infection. Pathogens enter the breast via the nipple fissures - these fissures are often the result of having sore nipples or other nipple trauma. Non infectious mastitis is also possible due to blocked ducts, engorgement, or physical injury to the breast; these problems can lead to localized inflammatory response of the breast tissue. Monitoring mastitis with ultrasound technology is helpful; the monitoring is helpful for showing resolution of the problem.

9. Ultrasound imaging is considered to be the most appropriate, initial, investigative tool to use to evalutate problems such as those listed above. If any of you have unresolved or ongoing breast problems after birth, consider "getting thee to an ultrasound.”

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