Management of Enlarged Montgomery Glands in Pregnancy and Lactation
Enlarged Montgomery glands during pregnancy and breastfeeding are a normal physiologic change that require no intervention or imaging workup when painless and without concerning features. 1
Normal Physiologic Changes
Montgomery glands become more prominent during pregnancy as a normal anatomic adaptation, occurring alongside areolar darkening and breast enlargement in most pregnancies. 1
These changes are driven by elevated estrogen and progesterone levels that stimulate breast tissue development and prepare for lactation. 1
The enlargement represents hypertrophy of these sebaceous glands in the areolar region and is completely benign. 1
When Observation Alone is Appropriate
For painless, bilateral, symmetric enlargement of Montgomery glands without associated mass, skin changes, or nipple discharge, reassurance and observation are sufficient. 1
No imaging is indicated for this normal finding. 2
The prominence typically resolves after cessation of breastfeeding during post-lactational involution. 1
Red Flags Requiring Immediate Evaluation
If any of the following features are present, proceed immediately to breast ultrasound as first-line imaging:
Palpable discrete mass in or around the areolar region, as imaging evaluation of any palpable lesion in pregnant or lactating women should not be delayed. 2
Unilateral presentation with tenderness and cystic changes, which could represent lactating adenoma or other pregnancy-specific masses. 3
Skin erythema, induration, or diffuse swelling involving one-third or more of the breast, which requires exclusion of inflammatory breast cancer or abscess. 4
Bloody or pathologic nipple discharge, which warrants diagnostic workup even in pregnancy. 2
Critical Management Principles
Breast ultrasound is the mandatory first-line imaging modality for any concerning breast finding in pregnant or lactating women, with nearly 100% sensitivity for diagnosis. 2, 4
Over 80% of palpable masses biopsied in pregnant and breastfeeding women are benign, but evaluation must not be delayed due to the risk of pregnancy-associated breast cancer (PABC). 2, 5, 3
PABC can present with falsely benign-appearing features and has more aggressive biology, making prompt evaluation essential for any suspicious finding. 2, 3
Common Pitfalls to Avoid
Do not assume all breast changes in pregnancy and lactation are benign without proper clinical assessment for concerning features. 3, 4
Do not delay imaging if there is any discrete mass, asymmetry, or concerning clinical feature beyond simple Montgomery gland prominence. 2
Do not proceed directly to mammography as the initial study, since ultrasound has superior sensitivity in the dense breast tissue of young, pregnant, and lactating women. 2