Q: “I am 20 weeks pregnant. Early on in my pregnancy I had bleeding from my right breast. My GP referred me to a consultant who, after a series of tests, said that I have a 2mm papaloma in one of my milk ducts. He thinks it is nothing sinister but says one can never tell until it is removed. Prior to the tests he had initially said that this is what he thought he would find and he wanted me to have it removed a.s.a.p.
However, he has now changed his mind and says that, because of the risk to the baby from having to give me a general anaesthetic, he would prefer to wait until post-delivery.
However, I have spoken to my antenatal consultant who says there is no reason why I shouldn’t have the operation whilst pregnant as the risk to the baby is very small. I am unsure what to do. I have to make a decision when I next see the breast consultant in 2 weeks. Should I get a second opinion on leaving the papaloma to post-delivery and a second opinion on the risks to the baby of having it removed now. How dangerous is a general anaesthetic when pregnant?”
A: The decision that you are trying to make is a difficult one, and it seems that you need more information before you will be able to come to one that you are happy with. In pregnancy it is wise to avoid medication as far as possible and some anaesthetic agents do have possible adverse effects upon the baby. However, general anaesthetics vary in their potential effects, and many women do have operations in pregnancy with no problems. The main risk associated with anaesthetic agents in early pregnancy is a possible increase in the risk of spontaneous miscarriage; around delivery the concern is that the baby’s breathing might be affected. The middle trimester of pregnancy is the safest time for operations to be carried out. To be certain of the exact anaesthetic drugs that would be used and their possible effects, you would need to have a discussion with an anaesthetist in the relevant department.
I would suggest that you ask to see your consultant again to discuss the risks and benefits of having the operation now or after delivery. It is important to consider the risk of malignancy (however small), and the possible effect upon your ability to breastfeed. If you leave the operation until after delivery you will need to be reassured that this is a safe decision otherwise you are likely to be troubled with anxiety throughout your pregnancy, which may affect your experience of pregnancy and birth in a negative way. Also, after delivery you will want to be immersed in life with your new baby, and you may find being separated to go into hospital upsetting and inconvenient (as well as it possibly having a negative effect on establishing breastfeeding). It might be helpful to ask your antenatal consultant to discuss the options with your breast specialist. If you can discuss the option of early operation with an anaesthetist you are likely to be reassured about its safety.
Dr Jo Lee, Babyworld Doctor.
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