Getting a Breast Exam by DrJim

Getting a Breast Exam
by DrJim

This concerns the situation of going to your doctor for a breast exam or mammogram and currently lactating because you induced. This applies especially to older women who would not be expected to be lactating by their doctor i.e.; those that are peri or postmenopausal.

When you induce lactation you will cause some changes in your breasts. Breasts are made up of the gland of the breast (the ducts and alveoli), and fat, which is throughout the breast and closely associated with the alveoli as it provides substance and energy that the alveoli use to make milk when lactating. When the breast is not lactating or in the resting phase the gland of the breast decrease in size with the alveoli getting smaller and some reverting to fat so the number decrease. The breast then has the consistency of the fat which is very smooth, soft and non lumpy. When lactating, the glands become much more prominent, more like a younger breast. The glands can be palpated and have more of a consistency of “fine lumpiness” somewhat like feeling a soft cauliflower head through a ½” of skin and fat. (This is probably not a good description but I can’t think of anything better). Young breasts are dense and glandular, older lactating breasts are also but not quite as much. Fibrocystic breast disease is a lumpy condition of the breasts that feels different than this. It is possible that some examiners may not be able to tell the difference between a lactating breast and fibrocystic breast disease. You need to tell the examining doctor that you are lactating and that you did it on purpose otherwise he may feel you have a disease condition.

When you induce lactation you ask the Pituitary to put out lots of Prolactin. The part of the Pituitary that releases the Prolactin may swell a little, but it is not a “Tumor”. This may be important if you have the misfortune of being sent to have an MRI of your Pituitary looking for a tumor. Again this should not happen if you tell your doctor that you are lactating on purpose.

There is a real problem which your doctor can be concerned about; When a woman has a problem with fertility- cannot get pregnant in spite of trying for a reasonable length of time or her menstrual cycle stops without reason or she starts to lactate spontaneously. Then the doctor is going to consider the possibility of a Pituitary tumor. The tumor involves the Prolactin producing part of the Pituitary, which is turned on and can’t be turned off. The Prolactin producing part swells to try to respond to an abnormal signal to it telling it to stay in overdrive. It gets bigger and bigger until it puts pressure on the optic nerves and visual loss starts occurring. The diagnosis of Pituitary tumor is made with an MRI and the treatment is to destroy that part of the Pituitary. Of course this is a draconian treatment because a good part of the rest of the Pituitary is destroyed as well which ends up messing up a persons hormonal system and life.

Anyone that is inducing lactation does not have a “Pituitary tumor” and does not need an MRI etc. So just please tell your doctor straight what you are doing and head off this problem before it starts.

DrJim

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