Managing breast problems after breastfeeding

The wonderful bond you create with your baby when you breastfeed is like no other. And experts agree that breast milk is ideal for your infant. Yet, breast problems after breastfeeding are common, ranging from uneven breasts to misshapen breasts.

Breast tissue is constantly exposed to different levels of estrogen and progesterone. These are the hormones that change during menstruation, pregnancy, breastfeeding, and menopause. Throughout your life -- but especially during pregnancy and when you are breastfeeding -- your breast size and shape may change significantly.

Breast size is determined by how much fatty tissue you have in your breasts. Lactation creates denser tissue in your breasts. And after breastfeeding, the fatty tissue and connective tissue of your breasts may shift. Your breasts may not return to their pre-breastfeeding size or shape. Some women's breasts stay larger, and others shrink. But sagging or staying full can be as much a result of genetics, weight gain during pregnancy, and age as a result of breastfeeding.

Does Breastfeeding Cause Sagging or Flattened Breasts?

Postpartum breast involution is the term that describes the shrinking of milk-producing structures of the breast to their pre-pregnancy size when they are no longer needed. But when you are nursing, the flow of milk can stretch the breast skin and tissue to some degree. That leaves some women with an "empty" or "stretched out" look to their breasts. It's a common breast problem after breastfeeding, but it's a cosmetic concern, not a real medical problem.

Women often fear that breastfeeding will make their breasts sag. But a study in 2007 showed that breastfeeding itself is not the culprit. Other factors that can change your breast appearance more than breastfeeding include:

BMI -- body mass index, a measure of your percentage of body fat
the number of pregnancies you've had
a large pre-pregnancy breast size
a history of smoking

Can Breastfeeding Misshapen Breasts?

Each breast after breastfeeding is independent. So what happens to one breast during breastfeeding won't necessarily happen to the other. Breast engorgement while breastfeeding, for instance, which is caused by congested blood vessels in the breast, is common while breastfeeding. Once it's resolved, it may leave one breast slightly misshapen. But again, this is usually a cosmetic, not a medical, concern. On the other hand, any dimpling or puckering of your breast may be a sign of a breast lump underneath. It should be evaluated by your doctor.

Do Asymmetric or Uneven Breasts Come From Breastfeeding?

Breast tissue extends up toward your armpit. So as breast tissue swells with milk and then shrinks again after breastfeeding, the contours of your bust may change. Many women have uneven breasts before pregnancy as well as after breastfeeding. It's possible for one breast to return to its pre-pregnancy size after breastfeeding while the other stays larger, or droops, or flattens more. Some women end up with one breast a full cup size smaller or larger than the other after breastfeeding and simply learn to love the body that nourished their babies -- no matter what its shape.

Should I Be Screened for Breast Problems if I'm Breastfeeding?

Most breast problems after breastfeeding are cosmetic changes, not real medical concerns. But it's wise to stay up-to-date on your regular breast screenings to ensure your breast health.

Breast self-exams are a simple way to monitor your own breast health and breast changes. If you feel comfortable doing it, examine your breasts once a month, even while breastfeeding. It's especially important to examine your breast in the months after you stop breastfeeding as your breasts change shape and size. Report any lumps or unusual nipple discharge to your doctor. Most lumps are benign (non-cancerous). But they should be screened for breast cancer.

A breast exam by your doctor can evaluate whether a breast problem after breastfeeding needs medical attention. Have your doctor perform a breast exam once a year, or any time you notice usual breast changes after breastfeeding.
A mammogram (breast X-ray) can diagnose a lump too small for you to feel. If you have a breast problem after breastfeeding, your doctor may advise a mammogram right away, rather than waiting for your regularly scheduled yearly or biannual mammogram. It's also safe to have a mammogram while breastfeeding if you need one. It won't affect your milk or your baby's health.

Call your doctor if you have any of these breast problems:

  • fever or flu symptoms, which could indicate a breast infection (called mastitis)
  • painful breasts (more than the discomfort related to breastfeeding)
  • dimpling or puckering of your breast
  • unusual nipple discharge, or a bleeding nipple
  • rash on your breast
  • a red, sore lump that may feel hot to the touch, which could be a plugged milk duct
  • nipple retraction (turned inward)
  • a lump in your breasts

A positive note: Breastfeeding actually decreases your risk of breast cancer. Women who have never breastfed have a slightly higher risk of the disease.

What's the Treatment for Misshapen or Asymmetric Breasts?

When breast size or shape changes radically after breastfeeding, some women consider cosmetic surgery. A breast lift, called a mastopexy, can be performed to reduce sagging and to reposition the nipple and areola (the dark circle around the nipple) higher on the breast. A thorough evaluation by a qualified cosmetic surgeon, including a complete breast health history, is advised before you consider surgery.