Breast Changes in Pregnancy: Nipples, Pain, Colostrum and What’s Normal

Breast changes in pregnancy start early and continue right up to the birth. Your breasts get bigger and heavier, your nipples and areolas darken, veins show through the skin and, from the middle of pregnancy, the breasts begin making colostrum, the first milk. Most of these changes are driven by hormones preparing your body to feed a baby, and most are completely normal. A few are worth getting checked, and knowing which is which saves a lot of worry.

This guide covers breast changes in early pregnancy, what happens trimester by trimester, sore and itchy breasts, nipple and areola changes, colostrum, how much your breasts grow and when to buy a maternity bra, and what your breasts look like after pregnancy. If you already have implants, our guide to how pregnancy affects breast implants covers the implant-specific questions, and our guide to when breasts stop growing explains how the same hormones shape the breasts at puberty.

When Do Breasts Start Changing in Pregnancy?

For many women, breast changes are the first physical sign of pregnancy. Rising levels of oestrogen, progesterone and prolactin start working on the breast within the first few weeks after conception, and tenderness, a feeling of fullness or tingling in the nipples can appear before a period is even missed. Not everyone notices these early changes, and their absence does not mean anything is wrong.

What Do Breast Changes Look Like in Early Pregnancy?

In early pregnancy the breasts often look fuller and feel heavier than usual, similar to the days before a period but stronger and longer-lasting. The nipples may stand out more, the areolas can start to darken, and blue veins may become more visible under the skin as blood flow to the breasts increases. Breast changes in early pregnancy are usually felt before they are seen: soreness and sensitivity tend to come first.

Breast Changes in Pregnancy Week by Week: Trimester by Trimester

Every pregnancy is different, but breast changes tend to follow a broad pattern.

First Trimester (Weeks 1 to 12)

The first trimester is when breasts feel most sore. The milk ducts begin to branch and grow, blood flow increases, and the breasts become fuller, heavier and more sensitive to touch. Nipples may tingle or feel tender when clothing rubs against them, and veins often become more visible.

Second Trimester (Weeks 13 to 27)

For many women the soreness eases in the second trimester, but growth continues. The areolas darken and widen, the small bumps on the areola become more obvious, and the milk-making cells start to function. In a study that measured women’s breasts before conception and throughout pregnancy, the first chemical sign that the breasts could make milk appeared at around 22 weeks (Experimental Physiology, 1999).

Third Trimester (Weeks 28 to 40)

In the third trimester the breasts reach their largest size of the pregnancy and feel heavy, so good support matters more. Some women notice colostrum leaking, stretch marks can appear on the breasts as the skin stretches, and the extra weight can contribute to upper back and shoulder discomfort.

Breast Pain in Pregnancy: Sore and Tender Breasts

Sore breasts in pregnancy are common and normal. The tenderness comes from rapid growth of the milk ducts and glandular tissue, extra blood flow and fluid in the breast, and the direct effect of pregnancy hormones on breast tissue. Tender breasts in pregnancy are usually worst in the first trimester and ease for many women as the body adjusts, although the breasts may feel sore again later as they become heavier.

What helps:

• A well-fitted, supportive bra. Many women find a soft-cup or seamless bra more comfortable, and a soft sleep bra at night.
• Getting measured again. Bras that fitted before pregnancy can dig in within weeks.
• Warm or cool compresses. Either can take the edge off soreness.
• Checking with your pharmacist or midwife before taking any painkiller in pregnancy.

Breast pain in pregnancy that is limited to one area, comes with redness, heat or a fever, or is getting worse rather than better should be checked by your midwife or GP.

Nipple Changes in Pregnancy

Nipple changes in pregnancy usually start early. The nipples get bigger, stand out more and can feel more sensitive or tingly, and they often darken along with the areola. Nipple changes in early pregnancy are one of the signs many women notice first, alongside sore breasts. A change in nipple shape is normal too: flat or inverted nipples often become more prominent during pregnancy, which can make breastfeeding easier than expected. If you are considering inverted nipple correction, it is usually best done once you have finished having children, as some techniques affect the milk ducts.

Areola Changes in Pregnancy

The areola often becomes darker and wider during pregnancy. Pigment changes in the skin are very common in pregnancy: in a prospective study of 60 pregnant women, 51 developed some change in skin pigmentation (Annales de Dermatologie et de Vénéréologie, 1994). The darker areola is thought to make the nipple easier for a newborn to find. Areolas usually lighten over the months after birth and breastfeeding, but they do not always return to exactly their previous size and colour; our guide to large areolas explains what is normal.

Montgomery Glands in Pregnancy: Bumps on the Areola

The small raised bumps around the areola are Montgomery glands (also called Montgomery tubercles). Everyone has them, but they become larger and more noticeable in pregnancy. They release an oily secretion that keeps the nipple and areola moisturised and protected during breastfeeding. They should not be squeezed or picked. See your GP if one becomes red, swollen and painful, as it can occasionally become blocked or infected.

Nipple Discharge in Pregnancy

Clear, yellowish or creamy nipple discharge in pregnancy is usually colostrum and is normal. Blood-stained discharge should always be checked by your midwife or GP, even though in pregnancy it often has a harmless cause.

Itchy Breasts in Pregnancy

Itchy breasts in pregnancy are very common. The skin stretches as the breasts grow, which can make it dry and itchy, and existing eczema often flares in pregnancy. Heat, sweat and friction under heavier breasts can also cause a rash in the fold beneath the breast; our guide to rash under the breast covers intertrigo and how to treat it. Moisturising with an unperfumed emollient, wearing cotton next to the skin and keeping the skin under the breasts dry usually helps.

Itching in pregnancy is common, but it can occasionally be a sign of a liver condition called intrahepatic cholestasis of pregnancy (ICP). ICP usually causes intense itching without a rash, often on the palms of the hands and soles of the feet and typically worse at night. It affects fewer than 1 in 100 pregnant women in the UK (RCOG patient information), but it needs prompt assessment. The NHS advises getting urgent help from your maternity unit if you have very itchy skin, itchy palms or soles, or itching that is worse at night (NHS).

Veins on Breasts in Pregnancy

Visible blue veins on the breasts are normal in pregnancy and can appear in the first few weeks. Blood volume rises during pregnancy and more blood flows to the growing breasts, so the veins under the skin become larger and easier to see, particularly on paler skin. Vascular changes in the skin are common in pregnancy: in the same study of 60 pregnant women, 50 developed vascular skin changes and 32 developed spider veins, almost all on the upper body (Annales de Dermatologie et de Vénéréologie, 1994). The veins usually fade after pregnancy and breastfeeding.

Colostrum in Pregnancy: When Does Colostrum Start?

Colostrum is the first milk: thick, rich and often yellowish, and produced in small amounts. The breasts become able to make it from the middle of pregnancy, as the milk-making cells mature under the influence of pregnancy hormones; full milk production only starts after the birth, when progesterone levels fall (Journal of Mammary Gland Biology and Neoplasia, 2007).

Some women notice colostrum leaking in the second trimester, many only towards the end of pregnancy, and some not until after the birth. All of these are normal, and leaking or not leaking does not predict how much milk you will make. Breast pads inside your bra help if you do leak. Some women are advised by their midwife to hand-express and store colostrum in late pregnancy, for example if they have diabetes; only do this if your midwife recommends it.

How Much Do Breasts Grow in Pregnancy?

Breast growth in pregnancy varies enormously. In a study that measured breast volume before conception and throughout pregnancy, the volume of breast tissue increased by an average of 145ml per breast by the end of pregnancy, with a range from 12ml to 227ml, and increased further to an average of 211ml by one month of breastfeeding. The amount the breasts grew in pregnancy was not related to how much milk the women went on to produce (Experimental Physiology, 1999). For context, each step up in cup size holds roughly 130 to 150ml (Plastic and Reconstructive Surgery, 2017), so an average pregnancy adds about a cup size, and some women go up considerably more.

It is also common for one breast to grow more than the other in pregnancy. Most women’s breasts are slightly different sizes to begin with, and the difference can become more obvious as they grow; our guide to uneven breasts explains why. If you already had large, heavy breasts, the extra weight in pregnancy can make neck, shoulder and back discomfort worse, so support matters even more.

When to Buy a Maternity Bra

Buy a maternity bra when your usual bras start to feel tight, which for many women is towards the end of the first trimester. Expect to be refitted as your breasts grow, and consider a nursing bra later in the third trimester, since your breasts will change again once milk comes in. Look for:

• A firm, comfortable band with room to loosen as your ribcage expands.
• Soft, stretchy cups that allow for size changes through the day.
• Wide straps to spread the weight.
• A flexible or soft-cup design. If you prefer underwire, make sure the wire sits on your ribcage and does not press on breast tissue.

Stretch Marks on Breasts in Pregnancy

Stretch marks on the breasts in pregnancy happen when the skin stretches faster than it can adapt. They are common: in the study of 60 pregnant women, 37 developed new stretch marks, most often on the abdomen (Annales de Dermatologie et de Vénéréologie, 1994). They start pink, red or purple and usually fade to paler, silvery lines over the months after pregnancy. Moisturising keeps the skin comfortable, although no cream has been shown to reliably prevent stretch marks; our guide to stretch marks after pregnancy covers the treatment options once your baby has arrived.

Breast Lumps in Pregnancy: When to See a Doctor

Pregnant breasts feel lumpier than usual because the glandular tissue grows and the whole breast becomes firmer, which can make it harder to notice a new lump. Most lumps in pregnancy are harmless, such as a fibroadenoma that grows under hormonal influence or a milk-filled cyst, but any new lump should still be checked rather than put down to pregnancy.

Breast cancer during pregnancy is uncommon, but it is one of the cancers most often diagnosed in pregnancy, and delays in diagnosis are a recognised problem because symptoms can be mistaken for normal pregnancy changes. Breast cancer can be safely diagnosed, staged and treated during pregnancy, and avoiding diagnostic delays is vital (Clinical Obstetrics and Gynecology, 2016). Ultrasound is safe in pregnancy and is usually the first test. See your midwife or GP if you notice:

• a new lump or thickening that does not go away
• blood from the nipple
• a red, hot, painful area of the breast, or a fever
• dimpled or orange-peel skin
• a nipple that has newly turned inwards
• a change in one breast that is not happening in the other

Breast Cancer Now has further information on breast changes during or after pregnancy.

Breast Implants and Pregnancy

Implants do not stop the normal breast changes of pregnancy. The breast tissue in front of the implant still grows, the nipples and areolas still darken, and most women with implants can breastfeed, particularly when the implant sits under the muscle and the incision was made in the fold beneath the breast; our guide to breast implants, pregnancy and breastfeeding explains more, including what to expect afterwards. If one breast changes shape suddenly, becomes hard or painful, or swells, have it checked.

What Happens to Your Breasts After the Birth?

After the birth, the breasts get bigger again as milk comes in, then gradually shrink once you stop breastfeeding. Some women’s breasts return to roughly their pre-pregnancy size; others are left smaller, emptier at the top or lower on the chest, because the skin and supporting tissue stretched during pregnancy. The areolas usually lighten over the following months.

It is the pregnancy, not breastfeeding, that drives most of these changes. In a study of 93 women seeking breast surgery after having children, older age, higher body mass index, more pregnancies, a larger bra size before pregnancy and smoking all predicted sagging, but breastfeeding did not (Aesthetic Surgery Journal, 2008). Our full guide to breasts after pregnancy and breastfeeding explains what changes, how long your breasts take to settle, and every option for restoring their shape.

Breast Surgery After Pregnancy

Where breasts have lost volume or dropped after pregnancy and it bothers you, the main options are a breast lift to raise and reshape the breast, a breast augmentation to restore lost volume, the two combined, or a breast reduction if the breasts have stayed larger and heavier. Many women combine breast surgery with a tummy tuck as a mummy makeover, particularly if they also have loose skin after pregnancy or diastasis recti. A large or stretched areola can be reduced with an areola reduction, and nipples that have stayed enlarged with a nipple reduction.

Timing matters, because the breasts keep changing for some months after you stop breastfeeding. At Centre for Surgery we do not perform cosmetic breast surgery during pregnancy or while you are breastfeeding. We ask you to wait at least three months after completely stopping breastfeeding, ideally around six, with milk production fully stopped, or six months after the birth if you did not breastfeed. It is also worth waiting until you have finished having children, since a further pregnancy will change the result.

Frequently Asked Questions

Breast Surgery After Pregnancy at Centre for Surgery

If your breasts have changed after pregnancy and breastfeeding and you would like to talk through your options, a consultation at Centre for Surgery is the place to start. You will see a GMC-registered plastic surgeon, and the surgeon who assesses you is the surgeon who performs your surgery. Our Baker Street hospital in central London is regulated by the Care Quality Commission and rated Good overall.

Phone: 020 7993 4849 | Email: contact@centreforsurgery.com | Address: 95-97 Baker Street, London W1U 6RN

References

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