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breast pain and bleeding

Hello-I am nursing my 2.5 year old son, usually about 4X a day and several times at night (he sleeps with me).
Last Friday I skipped 2 nursing sessions during the day (this has happened before with no problems--I am starting to wean him). The next day I noticed an extremely painful and somewhat hard area of my breast and that evening I had a very slight fever (only about 99.5, but my normal temp is 97). When I expressed milk, I noticed that from one duct (on the side of my breast where the pain was), bloody strings were occasionally coming out. Pinkish/orange in color. My fever was gone by the next day, and now (3 days after I noticed the pain), I feel pretty much back to normal, although still tired. However, I can still express a bit of blood/pus from that duct on occasion (not every time I try, but sometimes).

1. Does the fact that the blood is continuing mean an infection or clogged duct is still present? Do I need antibiotics even though the pain is almost gone and I'm no longer feverish?

2. Should I be worried about cancer in light of the bleeding nipple, especially since it is from one duct only and sticky? It is not happening spontaneously, of course, only when squeezed.

5 months ago I had an ultrasound of the same area of the breast where this pain started because i felt a tiny lump there. the lump doesn't seem to have grown, and nothing was seen on the ultrasound (in fact, the radiologist couldn't even feel the lump although i definitely can). she noted ductal ecstasia but said this wasn't unusual since i'm breastfeeding. i am 31 with a history of breast cancer in my family (maternal grandmother at a young age).
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1761039 tn?1316458235
Dear Sregeem,

I understand your concern.

There is no need to worry. Your symptoms are suggestive of an infection, considering that you are still nursing your son. A course of antibiotics is needed along with warm compresses to promote drainage. Antibiotics like flucloxacillin are often used and you should consult your physician for the same. Further, given that your son is 2.5 years old, I hope you have strated giving him other foods as well, as the energy requirements of these children are far greater than what just breast milk can meet.

However, the presence of bleeding cannot be ignored and even though, it is likely that it is secondary to infection and duct ectasia in you, I would suggest that you undergo a complete evaluation by a physician (including a mammography) to rule out breast cancer , given that you have a family history of cancer (even though the chances of this being cancer are minimal ).

Hope that this information helps and hope that you will get better soon.

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Best Regards,
Dr. Anil Thakwani
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