Breast conditions

1. BREAST CONDITIONS
DR RUKIA (MD)

2. MASTITIS
Is an acute inflammation of the interlobular
connective tissue within the mammary gland.
• The incidence of mastitis is 2–5 percent in
lactating and less than 1 percent in
nonlactating women
• The common organisms involved are
Staphylococcus aureus, S. epidermidis and
Streptococci viridans

3. Risk factors for mastitis
• Poor nursing.
• Poor hygiene.
• Maternal fatigue .
• Cracked nipple.
• Milk stasis.
• Previous history of mastitis
• Maternal or neonatal illness
• Trauma
• primeparity

4. Clinical Presentation.
• Fever
• Chills
• Myalgia.
• Severe pain and tender swelling in one
quadrant
• Warmth, swelling of breast.
• The overlying skin is red, hot and flushed and
feels tense and tender
Exam Findings
• Area of the breast that is warm, red, and tender

5. Mastitis

6. Treatment
• Breast support.
• Plenty of oral fluids.
• Rest.
• The infected side is emptied manually.
• Proper positioning of the infant during nursing
• Nursing is initiated on the uninfected side
• Analgesics eg. Ibuprofen 200mgtds 3/7 or
paracetamol 1gms tds 3/7.
• Antibiotics eg. Ampiclox 500mg tds 7/7 or
Erythromycin 500mg tds 7/7.

7. Complications:
• Breast abscess.
Prevention.
• Thorough hand washing.
• Cleaning the nipples and keeping them dry.
• General good hygiene.

8. BREAST ABSCESS
• Features are.
–Flushed breasts not responding to antibiotics
promptly.
–Brawny edema of the overlying skin.
–Marked tenderness with fluctuation.
–Swinging temperature.

9. Breast abscess

10. Management.
• Incision and drained under general anesthesia.
• Breast feeding is continued in the uninvolved
side.
• The infected breast is mechanically emptied.
• Antibiotics intravenous preferable.
• Analgesics.

11. Breast Engorgement
• Caused by exaggerated normal venous and
lymphatic engorgement of the breasts which
precedes lactation.
• This in turn prevents escape of milk from the
lacteal system.
• The primiparous patient and the patient with
inelastic breasts are likely to be involved.
• It usually manifests after the milk secretion
starts (3rd or 4th day postpartum).

13. Symptoms
• pain and feeling of tenseness or heaviness in
both the breasts
• Generalised malaise.
• transient rise of temperature.
• Painful breast feeding.

14. Treatment:
• To support the breasts with a binder or
brassiere.
• Manual expression of any remaining milk after
each feed.
• To administer analgesics for pain.
• The baby should be put to the breast regularly
at frequent intervals.

15. Prevention.
• To initiate breast feeding early and
unrestricted.
• Exclusive breast feeding on demand.
• Feeding in correct position.

16. Cracked nipple
• The nipple may become painful due to
– Loss of surface epithelium with the formation
of a raw area on the nipple.
– Due to a fissure situated either at the tip or the
base of the nipple.
• Cracked nipple commonly caused by incorrect
positioning and poor attachment.
• It is caused by
– Poor hygiene .
– Retracted nipple.
– Trauma from baby’s mouth .

17. Cracked nipple

18. Treatment:
• Correct attachment will provide immediate
relief from pain and rapid healing.
• When it is severe, mother should use a breast
pump and the infant is fed with the expressed
milk.
• Rest to affected nipple.
• The persistence of a nipple ulcer needs biopsy.
Prevention.
• Help the mother to correct position
• Local cleanliness during pregnancy and in the
Puerperium before and after each breast.

19. Retracted and flat nipple.
• It is commonly met in primegravida.
• It is usually acquired.
• Babies are able to attach to the breast correctly
and are able to suck adequately.
• In difficult cases, manual expression of milk
can initiate lactation.
• Gradually breast tissue becomes soft and more
protractile.

20. LACTATION FAILURE (INADEQUATE
MILK PRODUCTION):
The causes are:
• Infrequent suckling,
• Depression or anxiety state in the Puerperium
• Reluctance or apprehension to nursing (4) Ill
development of the nipples,
• Painful breast lesion,
• Endogenous suppression of prolactin (retained
placental bits)
• Prolactin inhibition (ergot preparations, diuretics,
pyridoxin).

21. Management
Antenatal:
• To counsel the mother regarding the advantages of nursing her baby
with breast milk,
• To take care of any breast abnormality specially a retracted nipple and
to maintain adequate breast hygiene specially in the last two months
of pregnancy.
Puerperium:
• To encourage adequate fluid intake
• To nurse the baby regularly
• Painful local lesion is to be treated to prevent development of nursing
phobia
• Metoclopramide, intranasal oxytocin and sulpiride (selective
dopamine antagonist) have been found to increase milk production.
They act by stimulating prolactin secretion. Metoclopramide given in
a dose of 10 mg thrice daily is found helpful.