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Thread: Need some advice: what are these lumps under my areola?

  1. #1

    Default Need some advice: what are these lumps under my areola?

    Hello,

    I have struggled with recurrent and persistent plugged ducts since giving birth about 7 months ago. (This is our third child; we have 3 kids under 6.) I think I have had about 20 cases, with a trend of getting plugs every week or two. These plugs became increasingly more difficult to resolve, with some lasting 1 week or more. I narrowly evaded mastitis twice. I spoke with my OB, my OB's NP, and an LC on the phone. They didn't have any special advice for me other than to keep up my strategies for getting rid of them: hot compresses, hot showers, hot baths, lecithin, pumping, etc.

    I also developed gastritis, skin rash, and vaginal itching between 4mo-5mos. I had a restricted diet due to the gastritis, so I resorted to eating bland, easy things like cereal and fruits to cover my nursing hunger between meals.

    In early December (6 months old then), I got a case of plugs that was VERY persistent, in both breasts, seemingly centered around lumps/plugs right under the areolae. We battled aggressively, but it lasted two weeks with no significant improvement. I had deep shooting pains inside my breast, esp. after feedings. I finally decided to see someone. I went to my PCP's nurse practitioner, who thought my skin rash was fungal. She thought my ductal issues were related to the same yeast infection. We then went on a number of treatment plans, spanning about 6 weeks now: (1) nystatin, (2) nystatin alternating with Diflucan, (3) Diflucan for a week, and finally (4) Sporonox 100mg/day for 4 weeks. She also prescribed Clotrimazole with steroid for my skin condition and put me on a yeast-free diet. The baby was also checked out for thrush by her pediatrician, and we treated her for two weeks on Diflucan although she did not have any symptoms. I had a culture done on my milk (which has not come back yet). The ultrasound showed everything was normal in my breast (no abscess or plugged ducts).

    Out of all the treatment plans, Sporonox has worked the best. I was feeling better and “emptier” after every nursing session. The shooting pains are basically gone. But the original lumps under my areolae are still unresolved. My PCP sent me to my OB last week. He gave me a good plan for battling my vaginal yeast infection, which I appreciated. But on the areola front, it was unsatisfying. He said my breasts look normal and did not feel any lumps in my breast. When I showed him the lumps under my areola, he said it could be some sort of “pimple,” and told me to exfoliate my areola with soap 2x day to get the excess skin off, implying that it will properly drain the milk out that is stuck. He also told me to pump and not nurse for a week to prevent the baby and I passing yeast back and forth.

    All that to say, the lumps still remain after 4 days of this new treatment and we are all exhausted. I actually feel slightly worse as I am not as good at pumping as the baby is at nursing and emptying my breast. My guess is that I had a yeast infection in my breasts at one point but it is now resolved. So these lumps under my areolae don't seem to be yeast or typical plugs (since they don't actually hurt and the ultrasound said I don't have plugs). My busy OB didn't spend much time explaining about the “pimple” idea so I don't really understand that. Do you all have any ideas? Have any of you had the same thing?

    Thank you in advance.

  2. #2
    Join Date
    May 2006
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    24,794

    Default Re: Need some advice: what are these lumps under my areola?

    Welcome to the forum! I'm sorry you've been having such a rough time. Kudos to you for sticking with nursing.

    I have a bunch of questions for you. I hope you don't mind!
    - Have you ever been treated with antibiotics, or has anyone ever suggested that the recurrent plugs and pain may be related to bacteria rather than fungal infection?
    - Has the baby been checked for tongue or lip ties?
    - The lumps you have under your areolae- are they visible on the surface of the skin? Or are they something you can feel, but not see? Do they look like pimples? If they look like pimples, do they seem to circle the areola?

  3. #3

    Default Re: Need some advice: what are these lumps under my areola?

    Thank you mommal for your empathy. Here are my answers:

    I was Group B Strep positive with my first pregnancy (2010), and I was treated with antibiotics during delivery. I also had a UTI at 1mo, also treated with antibiotics (2010). I had mastitis with my second child, and I took antibiotics then (2013). No one has suggested that it may be bacterial. I did not have fevers in the last 7 months, but I did feel achy and run down during some plug episodes. I took some ibuprofen to ward off the pain during those episodes, and the lumps eventually resolved except this current one.

    The baby has not been checked for tongue or lip ties, although an LC checked out her latch once in the hospital and it was OK.

    The lumps under the areolae are not visible on the surface. They do not look like pimples to me, but I can grab them with my fingers.

  4. #4
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    Default Re: Need some advice: what are these lumps under my areola?

    Thanks for answering those questions!

    Based on everything you describe, I'm thinking that your issue is probably thrush- the vaginal yeast infection plus the fact that treatment for yeast seems to have improved your situation leads me in that direction. But I'd be very interested to see the results of the culture. Because sometimes moms are treated for yeast- often repeatedly- when the problem is actually a low-level bacterial infection. The achy, run down feelings you had during some of the plug episodes make me suspicious that you might have a bacterial infection instead of or in addition to yeast overgrowth.

    It might be a good idea to have the baby checked again for lip/tongue ties, as those can explain repeat bouts of plugs and also pain which is often a dead ringer for thrush pain.

    The lumps don't sound like pimples to me. I mean, pimples are generally something you can see on the skin surface- they're plugged sebaceous glands. Perhaps what you are feeling is small plugs, just under the skin surface? If you look at the anatomy of the breast, you see that the milk-producing glands are like clusters of grapes, distributed throughout the breast- I'm imagining a small plugged area right beneath the nipple might feel like what you describe. As long as they aren't causing you discomfort, I wouldn't be particularly worried about them.

    What do you think?

  5. #5

    Default Re: Need some advice: what are these lumps under my areola?

    I tend to think that they are small plugs as well. After good nursing sessions and pressure massaging, the lumps feel better and smaller. But by the subsequent feeding they are back to their original size. The problem is that, when I go longer between feedings or if the baby does not eat well, the milk builds up behind the aforementioned lumps under the areola and causes plugged ducts. ;/

  6. #6
    Join Date
    May 2006
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    24,794

    Default Re: Need some advice: what are these lumps under my areola?

    Having the lumps shrunk after a good nursing session and re-expand in between feedings sounds like minor plugged ducts to me. Sometimes moms have plugs that slow drainage but don't completely stop it. Kind of like a bathtub drain that is closed half-way- the water drains out more slowly but does still drain.

    Have you tried using vibration to try to break up the plugs? A personal massage toy or the handle of an electric toothbrush held against the plugged area can sometimes help loosen things up.

  7. #7

    Default Re: Need some advice: what are these lumps under my areola?

    The half-draining plug idea makes a lot of sense to me. When I pressure massage them the milk comes out.

    Going back to OB tomorrow; hopefully he will let me nurse again and I will try the electric toothbrush idea too.

  8. #8

    Default Re: Need some advice: what are these lumps under my areola?

    Another question: what is the difference between the minor plugged ducts and galactoceles? I ask because although the lumps seem to "shrink" after each feeding, they have basically stayed their same size overall since about 2 months ago. If it is a galactocele, do I need to get it drained? The ultrasound showed no cysts or plugs, so does that rule out the possibility of a galactocele?

    Thank you again.
    Last edited by @llli*d.tombs; February 3rd, 2016 at 12:32 PM. Reason: additional info

  9. #9
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    May 2006
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    Default Re: Need some advice: what are these lumps under my areola?

    My understanding is that the basic difference is that a plugged duct eventually unplugs, whereas a galactocele does not. Since your lumps are changing in size, it suggests that they are simply persistent plugged ducts rather than galactoceles.

    The treatment for galactoceles is rather invasive- aspiration of the cyst contents or surgical removal of the cyst. It's not something you would want to do until you were completely done breastfeeding this child, and any future children as well. Any surgery on the breast has the potential to affect breastfeeding and milk production.

  10. #10

    Default Re: Need some advice: what are these lumps under my areola?

    An update to everyone (who has been reading, may read this sometime in the future--hope it is helpful!),

    I had a pretty satisfactory explanation from the OB last week. I was finally cleared of my ductal yeast infection (after 2 months!), but he said that it "scarred" my ducts in a way that it is always uncomfortable now. It explains why I have these "lumpy" feelings under the areola although an ultrasound didn't show any plugged ducts or cysts. Anyway, the good news is that it will heal if I am to breastfeed another child.

    Thank you for your support through this!

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