Breastfeeding After Diagnostic Breast Procedures

YES! Breastfeeding after diagnostic breast procedures is certainly possible!

Diagnostic procedures such as biopsies that remove sample breast tissue, aspirations to remove infectious or suspicious fluids from the breast, and excisions to remove tissue such as lumps typically have a mild to moderate impact on lactation.

More invasive procedures such as heart and lung surgeries may require cutting through breast tissue, which may damage ducts and/or nerves.

One of the most vulnerable periods for breast tissue is before puberty. The undeveloped mammary gland is very small, and invasive cuts during that vulnerable period can interfere with a greater number of ducts and nerves simply because they are closer together. This affects the final structure of the breast, including the number of intact nerves and ducts. 

Ultimately, the effect of the diagnostic procedure on the amount of milk that can be made depends upon the type of procedure, the timing, and whether or the breasts are currently lactating.

Although it’s common to be told to wean for days, weeks, or months prior to diagnostic imaging, aspiration, or biopsy, weaning is not usually necessary at all.  Yes, diagnostic imaging techniques may more difficult to interpret during lactation, but it’s far from impossible. In most cases, weaning is neither practical nor necessary. Research has clearly shown that abrupt weaning can be psychologically traumatic for both the parent and child, no matter how old the child is.  It could also lead to plugged ducts and breast infection (mastitis) from sudden milk stagnation. 

Surgeons may not be aware that weaning is a gradual process; milk can continue to be produced for many months. Residual milk will always remain in the ducts when surgery is performed on a recently lactating woman.

Although it may be more difficult for the surgeon during the procedure, the milk is bioactive, containing anti-infectious and anti-inflammatory agents. This means that the milk will reduce the likelihood of infection and accelerate healing. It will not contaminate the wound.

To minimize the amount of milk in the ducts that may make the procedure more difficult for the surgeon, just thoroughly drain your breast(s) by nursing or pumping immediately before the diagnostic surgery.

Ultrasound, aspiration, and biopsy procedures do not affect the quality or safety of the milk and are wholly compatible with breastfeeding. 

Core Biopsy

Core (needle or Tru-Cut) biopsy uses a large needle to remove a core of tissue from the center of a cyst. Typically, a small incision is made above the cyst and the needle is passed through the incision. Several tissue samples are withdrawn. If the suspicious tissue is malignant, a partial or full mastectomy may be necessary.

Core Biopsy Methods

Stereotactic biopsy isolates the precise location of a suspected mass using computer and mammogram imaging taken from multiple angles.

An Advanced Breast Biopsy Instrument (ABBI) uses very large needle and makes a large incision requiring stitches. 

A Mammotome Instrument (MIBB) removes tissue by suction in larger amounts than standard needle biopsy. 

Core biopsies can also be taken with a hand-held device, guided by ultrasound.

The impact upon lactation from core biopsy depends upon the extent, location, and direction of the incision as discussed above.  Scarring or the complication of an infection or hematoma after the biopsy may have an effect upon lactation, depending on the extent.

Ducts or nerves may be severed, depending on the location and direction of the incision.

• An incision on the lower, outer quadrant of the breast is more likely to damage the nerve that stimulates milk ejection.
  
  
• Horizontal incisions are more likely to severe ducts than vertical incisions. 

Ablative Surgery

A suspicious mass, such as a fibroma, may need to be removed completely.  Some surgeons will also remove fibroadenomas as large as lemons in order to avoid the remote possibility of malignancy (cystosarcoma phylloides), which is about one percent. In abscesses that are larger than can be treated with aspiration, an incision and drainage may be required.

As with all breast surgeries, the location, orientation, and extent of the incision will determine the impact upon milk production.    

Many surgeons attempt to preserve the cosmetic appearance of the breast by placing incisions in less visible areas, such as on the areola or under the inframammary fold (the fold under the breast).  If an incision on or around the outside of the areola damages the fourth intercostal nerve, nerve response to the nipple and areola will be reduced, negatively impacting milk production.  This cannot always be avoided, however.  When the suspected mass is under the areola or in the nipple, such as in Paget’s disease, incisions on the areola are necessary, although orienting them toward the upper and inner quadrants reduces the likelihood of nerve impairment. Locating the incision far away from a mass is not always a perfect solution, either, because  the surgeon must cut into the breast to reach the mass, which greatly increases the risk of severed ducts and reduced milk production. 

Wire Localization

When a mass cannot be felt by probing from the outside and core biopsy is not possible, a wire localization biopsy procedure may be performed by inserting a needle into the breast, guided by x-ray, through which a thin wire is passed.  The wire is positioned at the site of the suspected mass and the surgeon uses the wire to locate and remove the mass.  The risk to milk production in this procedure is in the location and direction of the initial incision and the amount of tissue removed around the wire. Most importantly, if the incision is near the lower, outer quadrant of the areola and severs the fourth intercostal nerve, milk production will be impaired.

In some circumstances, mastectomy may be necessary. If such a serious situation occurs to a nursing mother, breastfeeding is usually discontinued due to the toxicity of treatments such as chemotherapy, which can also affect milk production. If it happens prior to a new baby, however, and only one breast is removed and the remaining one has not undergone any other treatments, it is quite possible to produce a full milk supply from the remaining breast. 

Sternotomy

Sternotomy, surgery through the breast to treat heart or lung problems, carries the risk of negatively impacting future milk production. In order to preserve milk production capability and minimize scarring, it is common for the incision to be placed in the inframammary fold. A study in 1992 reported excellent lactation outcomes when the incision for sternotomy is made in the inframammary fold. This is likely to be true for most mothers, although the extent of the surgery and post-operative healing will be important factors. Even when the incision is in the inframammary fold, nerve and ducts can be severed. Post-operative infection can also reduce milk production by causing permanent damage to affected glandular tissue.