A baseline mammogram obtained before pregnancy shows a heterogeneously dense breast. Mammography of physiological changes in a 33-year-old lactating woman.Ī. A diagnostic imaging evaluation is recommended if pathological nipple discharge is suspected. However, persistent unilateral bloody nipple discharge can be a pathological condition that occurs secondary to infection, papilloma, or breast cancer. Spontaneous unilateral or bilateral bloody nipple discharge can occur during pregnancy and early lactation (in up to 20% of pregnant women and 15% of lactating women) due to proliferative changes in epithelial cells as well as increased breast vascularity. These physiological changes result in increased breast volume with associated palpable nodularity and increased firmness, making the clinical detection of palpable lesions difficult. After delivery, prolactin induces milk accumulation and corresponding lobular growth and distension, and oxytocin induces the milk ejection reflex and facilitates the maintenance of milk production. The fluid content of the breast also increases, accompanied by involution of the fibrofatty stroma. During pregnancy, the number and size of breast ducts and lobules increase. The breast undergoes various changes during pregnancy and lactation in response to hormones such as estrogen, progesterone, and prolactin. Normal Physiological Changes of the Breast during Pregnancy and Lactation
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