I sometimes focus so much on the general myths in lactation that I forget the MAJOR myths existing in my own specialty of breast surgery. Along with the myth that you can’t get a mammogram or MRI during lactation, the “feared milk fistula” is another one topping the list.
No recommended procedure should ever be avoided because of the “risk of milk fistula.” A temporary milk fistula will form with any intervention on the breast. But if lactation is managed well (i.e. a patient isn’t told to massage, pump and dump, pump to keep their breast empty, feed feed feed feed on that breast to keep it empty), it closes up within a few days to a week.
On rare occasion (for example, if an incision is made very close to the nipple and if a patient’s pump flange is traumatizing the site of the incision), a fistula may last a little bit longer. Even still, it will close with proper management.
The other issue that breast radiologists and surgeons need to remember is that a milk fistula is a tiny little area of a fluid that is MEANT to come out of the body. It is completely different than a pancreatic fistula or an entercutaneous fistula (intestine connecting with the outside world via the abdominal wall). These are extremely challenging to manage, often require admission to the hospital, patients must have daily electrolyte testing, and may need surgery to resolve.
So, there is NO SUCH THING as the “feared milk fistula.” The only thing we need to fear is our lack of medical education on the topic of lactation!
