Have you ever been referred for a mammogram or breast biopsy while nursing?
If you have, you may have been told that those procedures aren't possible during breastfeeding, and that you'll have to wean first. This is truly unfortunate, because both procedures can be done while breastfeeding – as can an MRI, and even breast surgery.
It can be hard to find breastfeeding-friendly information on this topic, so we're very happy to be able to share a post on the topic by Dr. Shannon Tierney, Breast Oncology Surgeon at the Swedish Cancer Institute in Seattle, Washington. It's excerpted from a post for the Best for Babes Foundation, with their permission.
- Mammograms CAN be done on a breastfeeding woman. Ideally, they should be done with an experienced mammographer who knows the woman is breastfeeding, as the images will be more complex. She should empty her breasts as much as possible right before the mammogram, either by nursing or pumping.
- Ultrasounds CAN be done on a breastfeeding woman – and the same issues apply. Ultrasounds, incidentally, can actually be somewhat useful therapeutically for breaking up a clogged duct.
- MRIs CAN be done on a breastfeeding mother, though it is not recommended just for routine screening (as is done in high risk women) because of lowered sensitivity. Gadolinium, the dye used for MRIs of the breast, barely gets into milk and is not absorbed by the baby’s gut, so it is safe – no need to pump and dump.
- Milk cytology can be done, but it’s often low-yield. It does have the advantage of being noninvasive, but needs a specialized pathologist and doesn’t usually rule out cancer.
- Needle biopsies (fine needle aspiration and core biopsy) CAN be done on a breastfeeding mother. The smallest needle that will get the diagnosis should be used, and the risk of milk fistula, which is chronic milk leakage, is very rare. There is no research on the incidence of milk fistulas with biopsies, but it’s rare enough that when it happens it gets written up as case reports! Incisions around the areola should avoid the lower outer border to keep from injuring the 4th intercostal nerve, and radial incisions (or an approach similar to what is done for C-sections, where the skin incision is made to be cosmetic and the inner dissection is done in a radial fashion) are recommended. The breast should be kept well drained with nursing or pumping before and after. Use of a local anesthetic like lidocaine is safe – no need to pump and dump.
- Surgery on the breast CAN be done on a breastfeeding mother. Milk fistula is still a risk, though that risk may not be reduced much by weaning as the breast could continue to make milk for months after weaning. The surgeon should be very careful with her technique – minimizing unnecessary damage to the milk ducts and avoiding the central breast if possible. Radial incisions and avoiding the 4th intercostal nerve (see above) are recommended. The breast should be kept well drained with nursing and pumping before and after. Most types of anesthesia will be out of the milk by the time the patient is awake and alert – at most, pump and dump once.
If you are expecting to have a biopsy while nursing, and would be willing to donate a milk sample for breast cancer research, check out the University of Massachusetts Breastmilk Lab! They are always looking for moms expecting biopsies who are willing to donate milk for their research.