Is breastfeeding incompatible with maintaining my own breast health?

(72 Posts)
abigboydidit Sun 14-Jul-13 20:13:39

Hi -

I have posted about this before & it is a bit of a saga so I will try to summarise. About one and a half years ago I noticed a lump in my left breast. I was still breastfeeding DS (then 6/7 months old) & this created a huge amount of barriers in terms of scanning and treatment options. They initially refused to offer anything other than a mammogram but then turned me away, saying it would be inconclusive due to the milk in my breasts. As DS was dairy intolerant and a bottle refuser, then finally accepted that I had to feed him and offered me 1st an ultrasound (results inconclusive because of milk - lots of eye rolling and sighing from the radiographer) and finally a core gun biopsy. Thankfully I was told it was a harmless "thing" and that it would not change size/shape/location.

It has now changed size and shape and location.

I went to the GP to be re-referred to the clinic which she did and I have been given an urgent appointment for 2 weeks time. However, I am still feeding my DD. She is only 5.5 months but the GP was insistent that I stop prior to the appointment so that I can get a mammogram. I haven't stopped but still have time to do so if I have to confused.

I do not want to be reckless with my own health but also don't want to stop feeding DD prematurely if it is unnecessary and just a case of making it easy for the clinic to follow their basic protocol, rather than offering a more flexible approach. I would appreciate any advice or experience as I am so confused. Thanks in advance.

littlemefi Sun 14-Jul-13 20:19:43

Is there a breast care specialist nurse available?
Or perhaps google any breast care helplines for advice?

AnaisB Sun 14-Jul-13 20:21:08

Hope you're ok. Sounds like a stressful time/decision.

No medical knowledge, but i'd just stop. Breastfeeding is making it harder to get conclusive results and thus delaying any treatment you might need.

Bunbaker Sun 14-Jul-13 20:23:51

I agree with Anais. Your health is very important. Besides you could juts carry on feeding from one side.

abigboydidit Sun 14-Jul-13 20:26:57

Thanks for your replies. There doesn't seem to be a nurse who can help. There is an infant feeding specialist nurse who I called and she gave me advice on moving to formula - she had no clue about how breastfeeding might impact on test results and treatment options. Despite the urgent referral, my GP still reassured me that the fact it was benign 1.5 years ago suggests it still will be but that they may just want to drain/remove it for my comfort. I suppose I just feel so astonished that the one thing I am doing which is supposed to protect my breast health is the thing which everyone in the service wants me to stop! Am really dreading the appointment as last time they made me feel like a total freak for feeding my DS despite the fact he was still a teeny 6/7 month old. Every session I had to justify why I was still feeding him and they were so reluctant to reveal that in fact there were investigations (the core gun biopsy) which were compatible with breastfeeding angry

Thesebootsweremadeforwalking Sun 14-Jul-13 20:29:59

What a rotten situation to be in, OP. Have you got a lactation consultant/ specialist BF midwife you could talk it over with? IME they tend to take a lateral view on BF-related problems and maybe they might have supported someone else through a similar situation before, so can advise?

abigboydidit Sun 14-Jul-13 20:31:29

I should confess that about a month ago I was keen to stop breastfeeding and persevered and have really been starting to enjoy it again..hence my reluctance shock

Thesebootsweremadeforwalking Sun 14-Jul-13 20:32:33

Sorry - cross-posted. If you're getting no support locally, how about La Leche League or NCT BF counsellors, if you can find one locally or by telephone?

Lagoonablue Sun 14-Jul-13 20:34:00

At 5.5 your child has had a good 'dose' of bfing. You are probably fine but best get everything checked out. Your child needs their mum and your health is really important.

Bert2e Sun 14-Jul-13 20:37:56
lastnightidreamt Sun 14-Jul-13 20:37:57

I hope that you find the breast clinic a bit better structured and more set up for this problem than the route you went last time.

From what friends have said, the urgent referral is standard practice for any lump in the breast - always within the 2 weeks - and in all of their cases, has been absolutely fine.

Wishing you the very best of luck.

Rummikub Sun 14-Jul-13 20:40:01

Wouldn't you still be producing milk in 2 weeks even if you stop feeding now? Think I was still producing milk months after I stopped ebf. Also agree with lagoon that you have given your baby a really good start with 5.5 months ebf.

Think you do need to speak to someone with more specialist knowledge.

sleepyhead Sun 14-Jul-13 20:42:20

At 5.5 months I would expect it to take quite a long time for the milk to disappear. It's not going to vanish overnight - how quickly do they want to do the mammogram?

As a previous poster has said, you could always stop feeding from the side with the lump and continue on the unaffected side for now. I suspect you could relactate quite easily if it turns out to be nothing.

abigboydidit Sun 14-Jul-13 20:46:50

Thanks everyone. Unfortunately it is the same clinic as before.. I was considering calling the consultant tomorrow to ask if I could have another biopsy, as I don't see why I have to have a mammogram (if there is a good reason for limiting the number then I will admit defeat ). That way if the results are good, I might be able to keep feeding? <clutches straws>

On my clunky phone so will check out links later, thanks so much.

Hi OP

- Just thinking it's a bit crap that NHS can't accommodate breastfeeding as a completely normal state for a woman and her breasts to be involved in !

Good luck to you all thanks

AidanTheRevengeNinja Sun 14-Jul-13 20:51:57

I would not ignore the lump, nor would I stop breastfeeding before I wanted to.

I would flat out insist on another core biopsy. You've had it before, you can have it again.

As you have found out, there are investigations compatible with breastfeeding. Yes, the interpretation is more complicated and involves extra work/specialist input. But as you rightly say, why should you compromise your own health or your daughter's to make life easier for healthcare professionals?

Ignore the eye rolling, the comments, the need to justify. Sometimes you have to advocate for yourself and your child and be the "difficult" patient, and sod what the HCPs think. I say this as a doctor in the NHS and also a mother of a 4 month old who has experienced being at the other end of the system recently.

And I do sympathise - I live in an area with low bf rates and despite my baby being so young, have already experienced the "oh are you still just breastfeeding?" comments from HCPs. The same ones who hammered in "breast is best" at all antenatal sessions hmm It is shocking hypocrisy.

AidanTheRevengeNinja Sun 14-Jul-13 20:52:52

And if you run into a lot of problems, insist on seeing a consultant breast surgeon to discuss the matter with someone who may (although by no means definitely will) be more informed.

abigboydidit Sun 14-Jul-13 20:53:08

Juggling you have just perfectly summarised my issue. Thank you! I may nick that phrase when I call the Doctor..

speak2me Sun 14-Jul-13 20:55:39

I've had something similar, only I had a benign lump - a fibroadenoma ('Breast Mouse') around 8 years before having DS. When I was pregnant I noticed the lump had grown in size & I was advised to wait until I had given birth and started BF to see if it was the same thing or had got smaller again. It didn't get smaller so I had an ultrasound and core gun biopsy (whilst still feeding DS - around 10 weeks old) and they confirmed it was still the fibroadenoma. The conclusion was to go for a further check up a few months after I've finished BF to see if this has allowed the growth to shrink - if not then it will probably be removed as is now classed as a 'giant breast mouse' due to its size. The check up appointment came but as I'm still feeding DS (now nearly 10mths) I have rearranged for next year. My hospital breast clinic were very pro-BF and throughout all appointments there was no mention of me having to stop feeding DS, infact when I called to delay the check up appointment they were very understanding about me continuing to BF.
I think if you can you need to push for ultrasound and a core gun biopsy straight away, hopefully the results from this will mean you can continue to BF your DD.

dumbelina Sun 14-Jul-13 20:56:17

I had a similar experience to you, one core biopsy was inconclusive while I was pregnant and a second one when DS was three months old gave the same result, they said possibly due to still breastfeeding. The healthcare staff were very supportive of me continuing to breastfeed, but they decided to remove the lump. I continued to feed right up until the op, when DS was four months old, stopped for 24 hours due to general anaesthetic. Thankfully the lump proved to be a benign fibroadenoma so once the anaesthetic cleared my system I was able to continue feeding and fed DS till he was 14 months. However I had clear advice from all involved including my Health Visitors and the specialist was very clear that with two inconclusive tests they would remove the lump to be safe. There was no question of getting me to quit breastfeeding and waiting a month or so for the milk to clear and retesting. My specialist basically said it could take months for my breast to return to 'normal' whatever that is so it was best to operate. Hope this helps, best of luck.

MonstersDontCry Sun 14-Jul-13 20:56:26

Could you just feed from one side?

dumbelina Sun 14-Jul-13 20:58:33

Also, you don't say how old you are, but I never had a mammogram as my specialist said they are pretty useless under the age of 40 as the breast tissue is too dense. I had ultrasound and biopsies both times.

Great ! Glad to help !

AidanTheRevengeNinja Sun 14-Jul-13 20:59:11

Sorry to keep posting, I keep thinking of things. Another advantage of being seen by a specialist such as an experienced breast surgeon is that he/she will be able to give you a good clinical assessment which will take into account your overall risk based on family and personal history, clinical features from examining the lump, etc, which will help you decide just how urgent things really are and what your options are. This can be much more valuable than just being put through the protocols. They may even be able to give a diagnosis on clinical grounds if the signs are very clear and bypass the need for investigations.

MsMunch Sun 14-Jul-13 21:01:28

Through work I sometimes meet women who have had to stop bf after being diagnosed with breast cancer and needing drug therapy incompatible with continued bf. These women are often still feeding at the point I meet them so their lactating status hasnt hindered their diagnosis. There will be many others who have had the good news that there is nothing to worry about who are still feeding. I think you will find very different attitudes in different teams.

It seems especially inappropriate to be dismissive of your wish to feed still whilst doing so is helpful to your long term breast health and there are already suspicions that ypur lump will be benign like before.

Good luck with finding what is right for you. If the hospital has a feeding specialist they may be of use to you.

abigboydidit Sun 14-Jul-13 21:03:21

Thanks everyone. I am 37. The last results letter said (I kid you not) that they had found a "non-malignant thing". thing?! I was told there would be no follow up & the consultant made it clear that monitoring would be out of the question while I was still breastfeeding.

abigboydidit Sun 14-Jul-13 21:04:30

Sorry - just to add am intrigued by feeding from one side! DD feeds from both sides every feed so would it be possible?

abigboydidit Sun 14-Jul-13 21:07:17

Please don't apologise Aidan! All v helpful grin

NachoAddict Sun 14-Jul-13 21:12:36

I was going to suggest just feeding from one side too but it seems from other posts that there are a few other options.

Good luck and stand up for yourself and your Dd.

Sunnysummer Sun 14-Jul-13 21:12:41

I had a lump and was told to continue feeding, but was able to have a mammogram, ultrasound and biopsy (overseas, not NHS). The only preparation I had to do was to fully empty the breast before the appt, so I fed DS in the waiting room and then expressed right before hand just to be sure.

Who was the 'they' who said you'd have to stop? If it was the consultant then I agree with previous posters that 5.5 months is a great amount of time already and that your health is the most important, but if it was the GP or radiographer maybe you can call the clinic and get a confirmation from the doctor before you go?

sleepyhead Sun 14-Jul-13 21:14:48

It should be possible. The supply to the unaffected side would increase.

It would be a bit of a faff though, so it'd be good to know that the requirement for you to stop was definitely based on clincal need.

kernowmissvyghen Sun 14-Jul-13 21:27:58

Have you considered asking your GP to refer you to a different (better) hospital?

You have the right to go to any NHS hospital you choose for treatment, and from the other replies on here it's clear that other hospitals have a far more patient-centred approach than your current hospital.

In your position I'm not sure I'd be at all keen to go back to the people who dealt with you previously.

abigboydidit Sun 14-Jul-13 21:30:37

Am in Scotland so my options are far more limited - the medical staff at my unit also cover the neighbouring health board. Am actually an NHS employee so had expected better shock

abigboydidit Sun 14-Jul-13 21:33:05

Sorry I meant to say it was nurses, GP and junior doctors saying to stop last time. The radiographer didn't say to stop but just refused to see me whilst I was still feeding! This time it was the GP telling me to stop before my appt.

abigboydidit Sun 14-Jul-13 21:33:55

And apologies if my replies are a bit stilted - still on my phone!

SoYo Sun 14-Jul-13 21:35:16

Even if you stop now surely you'll still be producing milk in 2 weeks time and they may still say this will affect tests etc? I'd carry on BFing and discuss it with them at the appointment and push them for alternatives if they feel it will alter the investigations.

abigboydidit Sun 14-Jul-13 21:48:02

On my laptop now so thanks Bert2e for the links - they are really helpful. speak2me dumbelina MsMunch Sunnysummer thank you for sharing your experiences.

midori1999 Sun 14-Jul-13 23:13:08

OP I am also in Scotland and have needed investigations at my local breast clinic. (I'm in Edinburgh, although I appreciate you may not wish to say where you are) the investigations I needed weren't for a breast lump, but the staff at the breast clinic were absolutely appalling in both their understanding of breastfeeding and support of it. In fact, the consultant I saw was open mouthed when he asked how long I intended to breastfeed and I replied 'at least two years'.

abigboydidit Mon 15-Jul-13 11:57:40

Thanks midori1999. I am disappointed but not surprised to hear my experiences are the norm..

Bert2e Mon 15-Jul-13 15:12:50

You could always say you've stopped bf - or rather just not tell them you're still bf!!

abigboydidit Mon 15-Jul-13 15:32:45

Just off the phone to the clinic. They wont do a mammogram and wont see me until I have stopped BFing. Couldn't get past the nurses to speak to the Doc sad

cardamomginger Mon 15-Jul-13 16:22:20

If they find something with the scan, they will do a core biopsy anyway. And even if they don't find anything that looks suspicious on the scan, I would hope they would still do a core biopsy, given that you have an existing lump.

As part of your conversation about going straight to biopsy, I'd press them strongly to tell you exactly what it is that the mammogram would show that no other investigation will show. If it is just a question of having to tick all the boxes on the form, that's one thing (and they can sod off). If it's because it will give clinically important information that cannot be obtained any other way, then that's another. Could it be relevant to determine whether there is just one lump or more than one? Don't know....

cardamomginger Mon 15-Jul-13 16:23:42

Swines. Is your GP supportive? Could he/she try and speak to consultant?

Bert2e Mon 15-Jul-13 16:38:49

Do they say how long you have to have stopped bf for?
You could stop for the appointment and then start again that afternoon!

Rather shocking isn't it that medical staff at a breast clinic don't seem to have an understanding of what breasts are for !

Llareggub Mon 15-Jul-13 16:52:06

What do the NICE guidelines say?

Rummikub Mon 15-Jul-13 16:53:24

Try calling hospital switchboard and speak to consultant's secretary? Think it's appalling that they won't discuss this with you. And what juggling said. Disgraceful.

PoppadomPreach Mon 15-Jul-13 16:58:35

Stop feeding. Get a proper scan.

There is a perfecty acceptable alternative to breast milk. There is not a perfectly acceptable alternative to a dead mother (yes I know alarmist and insensitive, but personally I wouldn't mess with what could potentially be cancer)

SoYo Mon 15-Jul-13 17:25:15

Leave a message for the consultant with their secretary. They cannot refuse to see you or treat you.

abigboydidit Mon 15-Jul-13 21:21:35

Thanks everyone. I guess I just have a stubborn streak and am getting irritated by the lack of support or options for women who are breast feeding. Also, now I understand that milk stays in my breasts far longer than I had appreciated, I feel even more strongly that stopping feeding at this investigative stage is pointless.

But I also know I can't play chicken with my own health. I will call the Dr's secretary tomorrow but if I have no luck I will start stopping from that side. hmm

midori1999 Mon 15-Jul-13 21:35:10

Sadly, IME, they still won't do anything if you dry up one side.

Presumably they are reluctant to do a biopsy due to the increased risks when breastfeeding? I do know there are some NHS consultant breast surgeons who are supportive of breastfeeding and prepared to biopsy or even operate on lactating women.

Does your hospital have a knowledgable breastfeeding advisor who may be aware of a more breastfeeding friendly surgeon or who could advocate for you?

Could you maybe try contacting an IBCLC who has experience of lactating women and breast surgery?

I can understand your reluctance to stop BF, particularly when the lump may still be benign.

tiktok Mon 15-Jul-13 21:45:10

poppadum, " alarmist and insensitive"....indeed, you said it sad

OP does not want to stop bf.

She does not want to be reckless with her health.

She does not need to stop, or to be reckless.

She does need a better assessment from people who understand bf, and who understand the physiology of it. I would not be confident in an HCP who thought that 'stopping bf' was an easy thing to do and that milk would just stop. To me, it is a give away - shows they do not understand normal lactation and I would wonder how competent they were to assess breast health, in that case.

OP, hope you find a good solution.

abigboydidit Mon 15-Jul-13 22:05:10

I have been given no reasons why they can't/won't do another core gun biopsy. It was 100% compatible with breast feeding but it seems mammogram is the first line. I will be honest and confess that I am now just stunned with the attitudes of the health care professionals I am encountering and probably just need to write a complaint.

abigboydidit Mon 15-Jul-13 22:12:24

Sorry. I didn't mean that to sound so grumpy. Am just feeling a bit picked on and sorry for myself!

BadSkiingMum Mon 15-Jul-13 22:35:57

I think that you urgently need to contact the 'drugs in breastmilk' helpline.
I realise that it is not a medication issue, but the helpline is probably an excellent place to start. It is run by a pharmacist who is also a breastfeeding expert.

The helpline can be found via the Breastfeeding Network site. The BFN also do some factsheets on different medical treatments which are really helpful.

BadSkiingMum Mon 15-Jul-13 22:39:55

Could one approach be to empty the breasts just before the mammogram (feed and pump like hell), then to give your baby expressed milk for a period of time?

Can anyone give you an estimate of how long the radiation will remain in the breast tissue? You could then 'pump and dump' for that period of time.

RedKites Mon 15-Jul-13 22:49:02

Could you speak to PALS at the hospital? Explain that they did a core gun biopsy before, and that they won't even meet with you to discuss why this isn't possible this time. I hope they would see that asking you to give up breastfeeding when you don't want to, without even having this discussion, is rather unreasonable.

Rummikub Mon 15-Jul-13 23:20:20

Hi, don't know if someone's already looked at la leche league site. Copy and post below:

Yes, breastfeeding mothers can have mammograms.

Mothers asking this question may have two concerns:

1. Will the radiation affect my milk and harm my baby?
2. Is it possible to read the mammogram of a lactating breast?

X-rays do not affect mother's milk, so you can safely resume breastfeeding immediately after the mammogram. In fact, according to the LLLI WOMANLY ART OF BREASTFEEDING, page 134, "Mammograms, x-rays and ultrasound tests will not interfere with breastfeeding."

The second question has a longer answer. It is possible to read a mammogram of a lactating breast. Breasts that produce milk are called lactating breasts. Due to milk production, there is more dense tissue present in the lactating breast than in a non-lactating one. This normal density may make it harder to read the results. The amount of tissue in your breast depends on the frequency that your baby is breastfeeding. If breastfeeding occurs infrequently, there will be less milk and tissue so the mammogram would be easier to read. To help reduce the amount of milk prior to a mammogram, you could bring your baby and breastfeed immediately prior to the procedure. Finding a radiologist experienced in reading mammograms of lactating breasts would produce more reliable results.

Sorry if you've already seen this, hope it helps.

BadSkiingMum Thu 18-Jul-13 23:01:33

Any update?

abigboydidit Fri 19-Jul-13 13:44:32

Sort of. I have been allowed to still meet with the Doc (the exact words of the secretary!) so that's next week. Still trying to seek out an advocate from the health board to support me hmm

SoYo Fri 19-Jul-13 19:03:20

Try ringing the maternity unit to get the number of the infant feeding coordinator. Pretty much all units have them now as its financially beneficial for them to be 'breast feeding friendly'. They're usually excellent for things like this. Ours did battle with pharmacy for me who refused to provide a drug that I'd prescribed a woman because their guidelines said it wasn't for use with breastfeeding despite years of experienced use across the world showing no harm.

Honsandrevels Fri 19-Jul-13 19:15:12

Have you contacted the bfn? They were hugely supportive to my questions about medication and bf. I was due to have a radio active scan thing (it is specifically for my condition but the name escapes me) and they were very helpful and gave me the go ahead. Then dd self weaned before the scan!

abigboydidit Fri 19-Jul-13 19:15:22

Thanks. She was my first port of call but unfortunately was only able to advise me on how best to move to formula so I would avoid mastitis. She was very nice though!

Lonelybunny Tue 23-Jul-13 22:41:12

Urm y can't you have an ultrasound scan on your breast ? I'm amazed this hasn't been offered ? I wouldn't give up breastfeeding yet and ask to have an ultrasound scan , if the scan is inconclusive then ask for a biopsy ? Disgusting as a mammogram is for older ladies with less dense breast tissue

Lonelybunny Wed 24-Jul-13 07:15:43

Ooh and I was told no point I could have a mammogram whilst breastfeeding as the milk would not make the picture clear enough hence the ultra sound scan , I'm
Still baffled why they won't do this for you ?

BadSkiingMum Wed 24-Jul-13 09:49:55

Any update op?

Lonelybunny Wed 24-Jul-13 15:16:33

Bump, op?

abigboydidit Thu 25-Jul-13 08:33:47

Appointment this afternoon! Will update once kids in bed. Thanks.

abigboydidit Mon 29-Jul-13 21:25:52

Sorry for the delay. I saw the junior Doc last week and she was v supportive of breast feeding. She sent me for a mammogram and ultrasound but the Consultant Radiologist refused to do the mammogram and went straight to ultrasound. As previously, that showed nothing so I had to have a core gun biopsy again. The Radiologist was about to steam ahead when I asked about whether the anaesthetic was okay for breast feeding which seemed to irritate her slightly and she said yes and then after pitting it in said she wasn't sure angry and to ask the initial Doc (it was fine, thankfully). Results later this week shock

AidanTheRevengeNinja Mon 29-Jul-13 21:35:11

Well that's a good result, all things considered. I'm glad you got a supportive/sensible doctor who was prepared to think outside standard protocol - shame it has to depend on the knowledge and experience pot luck of which healthcare professional you see rather than being part of policy. Good for you for standing up for yourself. Will keep fingers crossed for a nice clear biopsy.

Lonelybunny Mon 29-Jul-13 21:48:12

Please keep us updated , glad you've got somewhere.

Lonelybunny Sun 11-Aug-13 18:01:10

Did u get the results ?

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