Self-exams while breastfeeding? Yes, they’re important

Breastfeeding results in many changes to your body—and that includes how your breasts look and feel. While nursing can offer some protection against breast cancer, it doesn’t replace the need for regular breast self-exams (BSEs) or appropriate imaging when concerns arise.

Hoag OBGYN Lisa Karamardian, MD, Jeffrey M. Carlton Endowed Chair in Women’s Health, in honor of Dr. Anne M. Kent, answers common questions about breast self-exams during lactation so you can be informed, confident, and proactive about your breast health during this important stage of life.

Why is it still important to perform breast self-exams while breastfeeding?

Breast self-exams remain important during breastfeeding, though they require some adjustments and education due to the normal changes your breasts undergo during lactation. Even though breastfeeding itself offers some protective benefits against breast cancer, you shouldn’t skip self-exams during this time. While breast cancer during lactation is relatively rare, it can occur, and early detection is always important. However, detecting abnormalities can be more challenging when your breasts are producing milk. I like to educate patients that while breastfeeding, your breasts will feel different than usual and constantly be going through changes. Just as I counsel women that their breasts change throughout the menstrual cycle, the feel of your breasts changes when you are breastfeeding. For example, your breasts will be larger, fuller, and may feel lumpy due to milk-filled ducts. You might feel firm areas that represent milk buildup and texture changes throughout the day as breasts fill and empty. Breast engorgement can also create temporary hardness, and blocked ducts may feel like small, tender lumps that move and resolve.

How can women tell the difference between milk ducts and lumps that are potentially concerning?

At first touch, a clogged milk duct may feel like a potentially concerning mass, but further examination and evaluation can help determine whether there is a cause for concern. These are the things I tell patients to look for that may be warning signs that differ from normal breastfeeding changes:

• A lump that doesn’t move or change with feeding

• A persistent lump that remains in the same spot over several days

• Dimpling or puckering of the skin

• Nipple discharge that’s bloody (as opposed to milk)

• A lump that feels distinctly different from surrounding tissue

• Changes in only one breast when the other remains normal

Don’t hesitate to reach out to your healthcare provider if you notice any persistent or unusual changes. They can evaluate whether what you’re feeling is related to normal lactation or requires further investigation. Many findings during breastfeeding are benign (like mastitis or clogged ducts), but it’s always better to have concerning changes checked out. Breast massage, heat or warm compresses, frequent pumping and trying new breastfeeding positions can help resolve benign issues, but I tell patients that I am always here to help them discern these changes and to provide reassurance and workup when necessary.

What are other special considerations for breastfeeding women when it comes to BSE?

The best time to examine your breasts is right after nursing or pumping, when they’re at their softest and emptiest. This makes it easier to detect any unusual changes. Remember, knowing what’s normal for your breasts during this time is key to noticing when something changes.

Is it safe to get a mammogram while breastfeeding? Why or why not and are there different considerations depending on where you are in your breastfeeding journey/if you have any specific concerns about your breasts?

Yes, it is generally safe to get a mammogram while breastfeeding, and here are some important considerations to keep in mind. Mammograms use very low levels of radiation that don’t affect breast milk or pose risks to your baby. The compression involved doesn’t harm your milk production and you can continue breastfeeding normally before and after the procedure.

The main issue is accuracy—not safety. Breastfeeding breasts are denser and contain more glandular tissue and fluid, which can make imaging harder to read and potentially obscure abnormalities. This leads to more false positives (seeing something that looks concerning but isn’t). I like to educate patients about this before imaging, so they have realistic expectations and don’t get scared during the evaluation. If you need evaluation, try to schedule the mammogram when your breasts are least full (right after nursing or pumping) and let the technologist know you are breastfeeding so they can adjust technique if needed. Your doctor may also recommend additional imaging like ultrasound, which works particularly well in dense breast tissue and can aid in diagnosis.

Anything else to add on this topic?

Being a new mother can be an overwhelming experience, but taking care of yourself and your health should remain a high priority. I remind my patients when I see them postpartum that they have started a new chapter in their lives, but the same providers who guided you through your pregnancy are here to care for you and provide support during this next phase. When it comes to breast cancer, early detection is crucial to saving lives and the good news and message is that while breast cancer rates are increasing, we are diagnosing cancers earlier and have so much to offer women so that they can lead healthy lives. BSEs are relatively quick but can make a big impact in your health journey. Take the time to perform them regularly and engage your healthcare team to assist with any concerns.

Schedule your mammogram. Learn more about the Women’s Health Institute at Hoag.