Several changes in the breast occur with pregnancy. One of the earliest symptoms is an increase in the vascularity of the breast, associated with a sensation of heaviness, almost pain. This occurs at about the 6th week. By the 8th week, the nipple and areola have become more pigmented, and the nipple becomes more erectile. The Montgomery tubercles become prominent as raised pinkish-red nodules on the areola. By the 16th week, a clear fluid called colostrum is secreted and may be expressed from the nipple. By the 20th week, further pigmentation and mottling of the areola have developed. Figure 23-6 illustrates the changes in the nipple and areola.
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