Breast Health After Pregnancy By Lisa Glickstein, Ph.D, Triplet Mom Originally printed in January 2005 Once you get pregnant, your breasts go to work (whether you want them to or not). You are usually unaware of the changes that are occurring, except for the obvious - more cleavage! However, once you deliver, your breasts will need attention, whether or not you are going to nurse your babies. Here are some basic questions and answers about breast health after pregnancy: What do I need to do if I don't want to nurse? Your body will produce milk after delivery whether or not you want to nurse. Your breasts will engorge after one to three days and feel sore and swollen, you may have milk letdown when you are near your babies, and so on. Wear a snug-fitting bra day and night, avoid nipple stimulation, and take Tylenol as needed for pain. After a few days, the worst engorgement should subside, and the milk will dry up completely in one to four weeks. It is possible (although rare) to get mastitis even if you aren't nursing, so call your doctor immediately if you develop a red hard lump in your breast, or if you are running a fever. Can I breastfeed my premies? Yes you can! Even if your babies are born prior to 28-weeks gestation, your breasts will engorge after delivery. It may take longer for your milk to come in (up to four days). Pump diligently (every three hours during the day, and at least every four at night). Be careful, as women who pump exclusively are more prone to mastitis. Can I breastfeed my adopted baby or my babies delivered by my partner? Believe it or not - yes you can! By pumping or nursing every three to four hours, many women can induce lactation, even if they have never had a baby themselves! It is not a simple process, or possible for every woman, and therefore a consultation with a lactation specialist, and a lot of preparation and reading, are warranted. Finally, women (or men) can use a device called a supplemental nurser to allow the baby to nurse while receiving milk through a small tube placed at the nipple. This can also be helpful for women who want to nurse but are having a problem with milk supply, enabling them to have the nursing experience, without worrying about the babies' growth and development. How can I ensure an adequate milk supply? Frequent nursing - at least every two hours at first is normal. For women who truly feed on demand, it can be every 20-30 minutes for the first couple of weeks. Eventually, the babies' jaw muscles and stamina build up and the intervals lengthen out. It is important to nurse on one side only for each hour or two, so the babies will get enough of the richer hind milk, rather than the watery fore milk. Plenty of fluids, avoiding caffeine, and adequate rest (minimum five hours of sleep a night) round out the basics. If you still have a supply issue, a lactation consultant can often help discern if it is a nursing issue, or if an herbal supplement might help. How can I treat and prevent cracked nipples? The best prevention and treatment is Lansinoh ointment. This is medical grade lanolin (taken from sheep's wool). It is odorless, and will not interfere with nursing. It is very, very thick (if your house is cold it can be hard to get out of the tube!). Warm a small amount between your fingers and apply to the nipples after nursing or bathing. You don't need to remove it before your babies nurse. It important to treat cracks both for pain relief, and also to avoid catching infections from your babies' mouths and developing mastitis. Most people find that plastic nipple guards and shields don't work. As with most breast problems associated with nursing, cracking heals and stops three to six weeks after beginning to breastfeed. Can I prevent mastitis? Often, yes. Mastitis is an infection of milk that is trapped in a plugged duct. Nurse your babies frequently, drink plenty of water, and keep the milk ducts clear. You can do the latter by manual expression of the ducts before pumping (pumps are notorious for not clearing ducts), or nursing your baby in different positions (cradle hold, football hold). Be especially diligent with manual expression and/or nursing on that side if you notice a firm or hard area on your breast. Warm compresses may help, but it usually takes more than that to clear a blockage. Anecdotally, the fibers from cotton bras seem to increase duct clogging for some women. If you do get mastitis, it typically occurs only during the first few weeks of nursing. What if I get mastitis? You'll know you have mastitis if you develop a red, hard lump in your breast, run a fever (often high), and feel generally cruddy. Call your doctor right away to get antibiotics. You can generally still nurse if you are taking antibiotics and Tylenol. Speak to a lactation nurse or consultant if you are ever told to "pump and dump," as often doctors are unaware of current recommendations. Obviously, be sure the lactation specialist knows about any special conditions of your babies as well. What about other lumps in my breasts after pregnancy? Breast-feeding decreases the incidence of breast cancer in women. The decrease depends on the total number of months spent nursing. It is unclear why nursing decreases cancer risk. There is another condition, called granulomatous mastitis, which only occurs in women who have had children (whether or not they nursed). Unlike normal mastitis, it can occur several years after pregnancy. This is an inflammation of the breast, frequently due to an underlying infection. It causes a lump, which can lead to a cancer scare. It is treated with antibiotics (to treat the infection) and steroids (to decrease the inflammation). It is relatively rare, but tends to recur in women who have had it previously. In even more rare cases, it can be a sign of tuberculosis or an underlying autoimmune disorder. Will breastfeeding cause my breasts to sag? The good news is that this is a myth. The bad news is that pregnancy is what causes your breasts to sag. If you nurse, you will delay this temporarily! Wearing a good bra can help, but this is a biological process. If you choose to have the sagging reversed surgically, be aware that many breast lifts, augmentations ("boob jobs"), and reductions will make it impossible to breastfeed in the future (the milk ducts are disconnected from the nipple as part of the procedure to camouflage scars).