Mammography and Sonography in Breastfeeding Women

Originally published in the October 2017 e-Blender, La Leche League of New York

Jayne R. Charlamb, MD, FACP, IBCLC
Associate Area Professional Liaison, (AAPL) LLL NY
Associate Professor of OBGYN, Pediatrics and Internal Medicine
Director, Division of Breast Health and Breastfeeding Medicine
SUNY Upstate Medical University

Both mammography and sonography (ultrasound) of the breast can be performed safely while a woman is lactating. There is absolutely no reason for a breastfeeding mother to wean in order to undergo these studies whether they are performed for screening purposes or as part of a diagnostic evaluation of a suspected problem.

Neither a mammogram (which uses xray technology) nor an ultrasound (which uses sound wave technology) will affect the quality or the quantity (volume) of a mother’s milk. It is perfectly safe for a lactating woman to undergo mammography and/or sonography and then nurse her baby immediately afterward.

However, lactation can make it more difficult to interpret the images obtained with both mammography and sonography of the breast. Therefore, before deciding how to proceed, a breastfeeding mother and her physician should discuss the following:

1) Can and should the imaging be delayed until the mother is no longer breastfeeding? 

Imaging performed as part of a diagnostic workup (for a palpable mass, for example) should never be delayed because a woman is breastfeeding! Likewise, a mother should never be advised to wean in order to undergo diagnostic imaging of a breast problem. Quite notably, it can often take weeks to months for lactating tissue to revert back to the “normal” appearance of non-lactating breast tissue on imaging. It would be potentially dangerous and inappropriate to delay a diagnostic evaluation for that time period.

Often, though, mammograms and sonograms are used in healthy women to screen for breast cancer when there are presently no breast symptoms or problems. These are called “screening studies” (in contrast to “diagnostic studies” which are performed to evaluate a specific symptom or problem).

In cases in which a screening study is recommended, a woman should talk to her doctor about the pros and cons of undergoing breast screening imaging while she is lactating. Depending on her own personal underlying risk of breast cancer, and depending on her own thoughts about the benefits of screening compared to the risks of screening (such as false alarms and “overdiagnosis” of disease), a breastfeeding mother may choose to delay breast cancer screening imaging for some period of time. It should be noted that the breast tissue of a woman early on in lactation may be denser than later in lactation when a child typically nurses less frequently. Therefore, image quality may be better later on in lactation than during the early months of breastfeeding. This should also be considered when planning the timing of screening imaging. The decision of when to start breast screening imaging should be made after careful consideration and discussion with a physician who is well-versed in breast cancer risk assessment and screening.

2) Who will be interpreting the breast images? 

It may be helpful for a breastfeeding woman to have a mammogram or breast sonogram performed at a breast imaging center that uses dedicated breast radiologists (rather than radiologists who do not focus on breast imaging and who therefore have less experience interpreting breast images). A dedicated breast radiologist will be more likely to have a comfort level and expertise in interpreting images of a lactating breast.

3) How can the quality of the mammogram and breast sonogram be maximized? 

A lactating mother should attempt to have her breasts as “empty” as possible during breast imaging. She might bring her breast pump or her nursing child (and another responsible adult who can care for the child during the imaging study) with her to her imaging appointment. She can then remove as much milk as possible (through nursing, pumping, or hand expression) immediately before the breast imaging studies are performed. It is usually helpful for a breastfeeding mother to contact the imaging center in advance of the scheduled study in order to arrange a time and place for pumping or nursing before the imaging is performed. If such arrangements are not possible, she may be able to come up with a “creative” solution such as pumping or nursing in her car before going into the imaging center.

Additionally, a lactating mother who will be having a mammogram should discuss the possibility of using breast tomosynthesis (3D mammography) rather than traditional mammogram technology for her imaging. Tomosynthesis is better able to “see through” the dense breast tissue that is often present in lactating women. It can improve the ability to detect disease in the breast and may also decrease the likelihood of the “false alarms” which can lead to unnecessary procedures and unnecessary concern.

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