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Breast Tenderness During Pregnancy (and Other Changes in Your Breasts)

Bryan Jick, MD, FACOG

Reviewed by
Bryan Jick, MD, FACOG

One of the most common pregnancy symptoms is tenderness in the breasts. From the very beginning of your pregnancy, your breasts begin to change in order to prepare for the arrival of the baby, and breast tenderness during pregnancy is one of these changes. All these changes are normal, so there is no reason to be alarmed unless you are experiencing something extraordinary, such as bleeding from your nipples. If that’s the case, you should seek medical attention. As for the other changes, don’t panic; they are part of the natural process every woman goes through once conception has happened. Lets examine what changes are occurring and why.

Tenderness: As noted above, breast tenderness during pregnancy is one of the most common pregnancy symptoms. Various hormones are preparing your breasts for lactation (milk production), so that you can feed your baby after it is born. The milk ducts in your breasts are growing, and as milk production begins (or colostrum production, to be more precise—see below), they are becoming stretched. This makes your breasts sore, especially your nipples.

Early pregnancy breast tenderness is usually much worse during the first pregnancy compared to later pregnancies. This is because normal breast development is not complete until the first pregnancy. Prior to this, breast glands are in a dormant state. The hormones of the first pregnancy cause rapid changes in growth and development of the breast milk-producing glands, which leads to the severe tenderness. On subsequent pregnancies, these changes are less pronounced.

Increase in size: When you become pregnant, your breasts begin to increase in size due to the milk glands growing and preparing to make milk for the baby. This increase in size can be substantial—you may gain two cup sizes or more—and it can make your breasts feel tender and unnaturally heavy. Also, as your breasts increase in size, you’ll notice that veins are beginning to show. Again, this is normal.

Stretch Marks: As your breasts grow, your skin must naturally stretch in order to accommodate this growth. This may cause itching, and you may eventually see striae, also known as stretch marks. These marks are apt to appear on your growing belly and breasts. Our skin comprises three layers— the subcutis (the inner layer), the dermis (the middle layer), and the epidermis (the outer later); stretch marks appear in the dermis, which is why they do not completely go away after delivery.

Approximately 80 percent of women get stretch marks during pregnancy, and the severity of these marks (and whether you get them at all) depends on the elasticity of your skin in particular. Unfortunately, while there are many over-the-counter creams and oils available that claim to prevent stretch marks, there is no evidence that any of them really help. This includes cocoa butter, lanolin, coconut oil, baby oil, aloe vera and others. They may smell good and feel good, and they are safe to use, but no studies have shown that any of these actually work to reduce or prevent stretch marks.

The good news is that stretch marks often fade away on their own, given sufficient time. If you get stretch marks and they do not fade away within a year or so, there are procedures such as laser therapy that may help. Topical Retin-A or Renova (not to be used during pregnancy) has also been shown to help reduce stretch marks.

Nipples: Your nipples will also increase in size and become more prominent, and in the later stages of pregnancy you may experience leakage of a substance called colostrum. Colostrum can leave a crusty substance on your nipples. This too is normal. Colostrum is usually clear and viscous, with a yellowish tint. If the colostrum is red or reddish, it means blood is present. Occasional blood leakage from the nipple is not necessarily a cause for concern—it is usually due to the sudden growth of the blood vessels, which is normal—but you should contact your doctor nevertheless, just to make sure that the blood leakage is not a symptom of a medical problem. If there is any discharge from your nipple that does not appear to be colostrum, contact your doctor immediately.

Some women have inverted nipples, which may remain that way for years. Usually these will revert back to a normal position during pregnancy, and you should still be able to breastfeed. Sometimes small pieces of skin grow on the nipple. These are tiny skin tags, and these can grow in many area of the body during pregnancy. Your doctor may advise having them snipped off under local anesthesia before delivery.

Areolas: Your areolas will grow larger and become slightly darker in color. The darker color helps the baby to distinguish nipple from skin, making it easier to latch on. You may also notice small bumps on the surface of your areolas. These bumps are called Montgomery’s tubercles. These are harmless, and the oil they produce actually provides an antibacterial shield and keeps the nipples from drying out and cracking. You should only rinse them with water and not soap, to ensure that you don’t wash away your body’s natural defense against germs.

Bras: As noted above, the sudden increase in size that accompanies pregnancy can cause you to gain a cup size or two, or possibly even more. For the sake of your own comfort, you will need to change the type of bra you wear. Some people will tell you to avoid underwire bras because the wiring can somehow interfere with the function of the milk ducts, but there is no evidence to support this belief. There is no reason not to wear an underwire bra, provided it fits well and the wires don’t dig into your flesh. Most women find maternity bras to more comfortable, however. The advantage of maternity bras is that they include extra rows of hooks, making it possible for you to adjust the bra as your breasts get larger. It may also be a good idea to put pads in your bra in order to absorb any colostrum or milk that may leak out during pregnancy or breastfeeding.

If you plan to breastfeed your baby, you may want to consider being fitted for a nursing bra. Nursing bras are equipped with cups that unzip or unhook, exposing the breast, which makes breastfeeding more convenient. The best time for such a fitting is a month or two prior to your due date; by this time your breasts will have grown as large as they are going to.

Talking to Your Doctor

Remember, these changes will not happen overnight, but only gradually as your pregnancy progresses. Many women experience breast tenderness as their menstrual cycle approaches; this does not mean you are pregnant. Only a pregnancy test will conclusively determine whether you are pregnant. Here are some questions you may want to ask your doctor:

  • Is there anything that can be done to prevent stretch marks, or to get rid of them after I am done with childbirth and breastfeeding?
  • Is the leakage from my breasts anything to be concerned about, or is it just colostrum?
  • Is there anything that can be done about the soreness and tenderness in my breasts?


Medical References:

    Stanford School of Medicine http://newborns.stanford.edu/Breastfeeding/ National Institutes of Health http://www.nlm.nih.gov/medlineplus/ency/article/003287.htm Mayo Clinic http://www.mayoclinic.org/diseases-conditions/stretch-marks/basics/treatment/con-20032624 British National Health Service http://www.nhs.uk/ipgmedia/national/breast%20cancer%20care/assets/breastchangesduringandafterpregnancybcc22pages.pdf The American Pregnancy Association http://americanpregnancy.org/pregnancy-health/breast-changes-during-pregnancy/ March of Dimes http://www.marchofdimes.com/pregnancy/breast-changes.aspx Planned Parenthood http://www.plannedparenthood.org/health-topics/pregnancy/stages-pregnancy-23953.htm WomensHealth.Gov http://www.womenshealth.gov/breastfeeding/index.html http://www.womenshealth.gov/pregnancy/you-are-pregnant/stages-of-pregnancy.html http://www.womenshealth.gov/pregnancy/you-are-pregnant/body-changes-discomforts.html#b
[Page updated April 2015]