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Ask the doctor: How long after weaning do breasts return to normal?



Be alert to nipple changes after weaning

Be alert to nipple changes after weaning

Be alert to nipple changes after weaning

Q I finished breastfeeding over a year ago and my breasts are still big. I had a hard time with feeding - lots of blisters and thrush, and one of my nipples is white. I check every now and then and there is still milk. I fed my baby for over a year. How long will it take for everything to go back to normal? Also, does this mean my hormones are still out of whack?

A There are many factors involved in successful breastfeeding. When it doesn't work out, I like to remind women not to feel guilty as many generations of babies were fully bottle-fed and we all turned out just fine! Breastfed babies, particularly, need daily vitamin D supplementation (formula contains vitamin D) and breast-feeding mothers should take daily calcium with vitamin D supplement to keep their bone density healthy and strong.

I am a strong advocate of breastfeeding and I am glad you gave it a try and managed to feed your baby for some time. Indeed, the first few weeks of breastfeeding are often the most difficult, with your milk 'coming in' and the 'toe-curling' nipple pain as the baby takes the first few sucks, but once you get over this it's generally plain-sailing. You seemed to suffer with one of the common difficulties, namely cracked nipples and secondary thrush infections. Although it can be uncomfortable, thrush is easy to treat with topical cream and oral antifungal medication/drops for the baby if there are signs of oral thrush. Thereafter, it's important to ensure your nipple cracks heal up by using protective nipple ointment, as this will reduce your risk of recurrent thrush.

Despite giving up breastfeeding a year ago, it is normal to notice some drops of breast milk, particularly during/after a warm shower or the occasional breast-milk stain on your bra. This may go on for a number of years and will eventually stop. You mentioned one of your nipples is white. This could be residual thrush. I suggest you attend your GP practice and ask for a swab of the nipple region to be sent to hospital for microbiology analysis.

In terms of breast cancer, you should also be alert to any change in the nipple (new onset nipple inversion or itchy, flaky, scaly red skin on the nipple), any area of the breast that becomes 'puckered' or has an 'orange-peel effect', or a painless (doesn't hurt when you push down on it) pea-sized lump that is fixed or difficult to move within the breast tissue. Should you notice any of the above or brown/blood-stained discharge from your breast, then you should attend your GP to arrange a breast ultrasound (if under 35) or mammogram if over 35 years old.

It is unusual for you to feel that your breasts are still big despite finishing breastfeeding. The vast majority of women notice a loss of volume and drooping of the breasts within a few weeks. Firstly, I wonder if you might have gained weight in the past year? It is most likely an overall increase in body fat versus the mammary glands in your breast tissue failing to shrink in size post cessation of feeding. Secondly, it is well known that the natural ageing process results in breast changes causing the breasts to lose firmness and develop a looser appearance. Thirdly, I wonder if you are taking any contraception as some of the oral pills may increase your breast size, thus your breasts may have stayed a similar size. Conversely, I assume you are not pregnant!

Lastly, I think it would be worthwhile getting your serum oestrogen (oestradiol) level tested as this declines with age, resulting in breast changes. If there is a family history of early menopause or your menstrual cycle has become more irregular, you should also research the symptoms of peri-menopause and have your FSH (follicle stimulating hormone), thyroid hormones and prolactin (milk-producing) hormone levels checked.

Dr Jennifer Grant is a GP with the Beacon Hospital HealthCheck

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