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MS.SASIKALA.N
MSC (N),OBSTETRICS AND GYNECOLOGICAL NURSING
LECTURER
GANGA COLLEGE OF NURSING
COIMBATORE
Breast Complications
Content Overview
• Introduction
• Anatomical variation
• Breast complications
Breast Engorgement
Cracked or Sore nipple
Inverted Nipple
Nipple Infection
Mastitis
Breast Abscess
Raynaud's Phenomenon
Introduction
A midwife
• Must ensure that the baby is adequately fed at the
breast.
• Must help the mother to develop necessary skills
to feed her baby by herself.
• Must know about the different breast conditions
which may effect on feeding and many
complications which can arise after delivery.
Anatomical Variations
Abnormally Long
Nipple
Inverted or
Flat Nipple
Long Nipple
Short Nipple
Long Nipple
It leads to poor Feeding because the baby is able to
latch on to the Nipple without drawing the breast
tissue into his mouth
Short Nipple
It doesn’t cause any problem as the baby has to form
a teat from both the Breast and Nipple.
Abnormally Large Nipple
• In this case, if the baby is small then his/her
mouth may not be able to get beyond the nipple
and on to the breast.
• Lactation should be initiated by expressing.
Inverted or Flat Nipple
If the nipple is deeply Inverted it is necessary to
initiate Lactation be expressing.
Breast Complications
Breast Engorgement
Cracked or Sore nipple
Inverted Nipple
Nipple Infection
Mastitis
Breast Abscess
Raynaud's Phenomenon
Breast Engorgement
Define : Breast Engorgement
• It is a condition in which there is a congestion or
increased vascularization which leads to
accumulation of Milk and edema.
• Caused by the Congestion and Obstruction of
Lymphatic drainage.
ONSET :
Usually manifest at 3rd or 4th day of
postpartum
Mechanism
Milk retention in the alveoli
causes alveolar distension
Duct compression and Milk flow
obstruction
Deterioration of alveolar
distension
Increased obstruction
Later, edema due to vascular
and lymphatic stasis.
Symptoms
 Pain & Feeling of tenseness
 Heaviness in both the breast.
 Generalized Malaise
 Even Transient Rise of Temperature.
 Painful Breast Feeding.
 Breast – Feels hard, Edematous and sometimes
Flushed.
Prevention
Start nursing as soon as possible.
Avoid pre- lacteal feeds
Breast feeding on demand.
Initiate breast feeding early and feeding at
frequent intervals.
Feeding in correct position.
Management
• If the areola is engorged, manually express some
milk before breast feeding.so that the areola gets
soft enough for the baby to grasp it properly.
Cont..
• Ask the Mother to breastfeed on a regular basis
and also on demand.
• Massage the breast.
• Use systemic Analgesics/Anti inflammatory drugs.
• Breast pump if needed.
• Advice the mother to wear a well-fitting
supportive bra.
Cont..
• Apply warm compress to help the ejection of milk.
• Apply cold compress after or between to reduce
edema, vascualrization and pain.
• Application of cabbage leaves on affected breast is
very effective intervention in reducing the breast
engorgement.
• So, education social health activist workers,
trained dais and public health nurse who working
in community setup.
2. Cracked or sore nipple
Normal Nipple
The Nipple is not only the structure to deliver
milk to the infant, it also contains small, sebaceous
gland or Montgomery glands to lubricate the skin of
the areola.
Define : Cracked Nipple
• It is Nipple trauma or Nipple fissure occurs when
there is disruption in the skin integrity and the
surfaces epithelium is lost.
• The crack can appear as a cut across the tip of the
nipple and may extend to its base.
Causes
• Improper positioning and inappropriate latch on.
• Short /flat or inverted nipples
• Oral dysfunctions in the infant, excessively short
frenium
• Prolonged non nutritive sucking
• Not breaking suction before taking the infant off of
the breast
• Use of creams and oils that cause allergic reaction
on the nipple.
Cont..
• Use of nipple shields and prolonged
exposure to wet nursing pads.
• Improper use of breast pump.
Signs and symptoms
Pain when the baby lasts longer than 30seconds
Crackling
Blisters
Bleeding and Nipple that are tender between
feedings
Nursing Management
 Encourage the mother to offer the least affected
breast first.
 Ask the mother to express enough milk before
breastfeeding to stimulate the let down reflex, thus
preventing the infant from sucking too vigorously
on the breast.
 Teach mother to alternate between different
positions, reducing the pressure on sore areas or
on damaged tissues.
 Use oral systemic analgesics, if necessary.
Cont..
• Apply emollient creams : e.g. lanolin based creams
or coconut oil.
• This can soften the skin and reduce cracking.
• Even breast milk can apply to the nipple this can
prevent the cracking and it has antibacterial
properties.
• Advice the mother to avoid using soaps,
deodorants, body powder and other substance
which cause allergic reaction that could dry out
the nipple.
Inverted nipple
• An Inverted Nipple is a condition in which the
nipple is pulled inward into the breast instead of
pointing outward.
• Also be called Nipple Inversion, Nipple Retraction
or Invaginated Nipple.
• Nipple retraction can be congenital as a normal
variant in some women.
in some case, it may arise as a result of disease
or trauma.
Causes
• Disorder by birth
• Due to breast feeding
• Pregnancy
• Breast infections
• Sudden weight loss
• Recurrent infections
Grades of Inversion
Grades Description
Grade I A person can easily pull out the nipple, and it
maintains its projection. the grade of inversion
causes no major problems with breastfeeding.
Grade 2 A person can pull the nipple out, but not easily
and the nipple tends to retract. they may find it
difficult to breastfeed.
Grade 3 A person may not be able to pull out their nipple.
when pressing the nipple outward.it immediately
retracts. Breastfeeding may be very difficult or
impossible.
Impact on Breastfeeding
• That inverted and flat nipples were one of causes,
along with many other factors, of delayed onset of
Lactation.
• Among mothers, first time they have been shown
to act as important barriers to weight gain.
Treatment
Hoffman Technique Syringe pull method
Nipple infection
• Breast infection caused by candida albicans in the
puerperium is quite common.infection can be
superficial or affect the Lactiferous duct.
Treatment
• Mother and Infant must be treated simultaneously
• Treatment is initially topical
Nystatin
Clotrimazole
Miconazole
Ketoconazole for about 2 weeks
• This topical can be applied by women after each
breast feeding and do not have to remove before
the next breastfeeding.
Cont..
• Gentian violet 0.5 at 1% can be used on the
nipples/areolas and in the mouth of the infant
once a day for three to four days.
Nursing management
• Advice the mother to perform breast care before
and after feed.
• Ask her to clean the baby’s mouth after feed.
• Each her to maintain proper personal hygiene.
Mastitis
• It is an Inflammatory process of one or more
breast segments that may or may not progress into
bacterial infections. It usually occurs in the second
and third weeks after delivery.
Causative organism
• Most cases of mastitis result from infection with
Staphylococcus areus.
Causative factors:
• Scheduled feedings
• Infants long sleep period at night
• Use of pacifiers or bottles.
• Failure to completely empty the breast
• Short frenulum, infant with a poor suck.
• Excessive ,milk production
• Separation of mother and infant and abrupt feeding
• Maternal fatigue facilitates the development of mastitis
Symptoms
• Acute onset of Maternal Fever(100 ̊ F or higher)
• Malaise and Chills
• Myalgia
• Breast tenderness associated erythema
• It is commonly unilateral.
Erythema usually in the upper, outer quadrant
with variable degree of induration.
Diagnosis
• Milk may be expressed from the affected breast for
determination of leukocyte.
• Culture of the breast milk also may be performed
to guide antibiotic therapy.
Treatment
• Antibiotic therapy
• Analgesics, such as ibuprofen or acetaminophen,
may be taken for symptomatic relief.
Nursing management
 Encourage mother for proper emptying of the
breast with maintenance of breast feeding.
 Manual milk expression after feedings, if necessary
despite the presence of bacteria in breast milk in
case of mastitis, breastfeeding should be
maintained, as if it does not pose any risk to healthy
full term infants.
Cont..
• Mother should be encouraged to initiate feeds on
the unaffected breast and change the infants
position at different feeds.
• Increased fluid intake and adequate nutrition
should be encouraged.
• Either cold or warm compress may be used for
comfort.
• Advice mother to wear non constricting breast
support.
Breast abscess
• Breast abscess develops as a complication of
mastitis in 5-11% of women.
• Usually occurs in first 12 weeks after birth or at
the time of weaning.
• It is referred to as puerperal or Lactational
abscess.
Treatment
• Incision and drainage of abscess
• Parenteral antibiotics
• Fluid from the abscess should be cultured and
results used to determine ongoing antibiotic
treatment.
• Needle aspiration of the abscess repeated every
other day until the pus no longer accumulates has
been suggested as an alternative open drainage.
Surgical Aspiration
Raynaud's phenomenon
• An Intermittent Ischemia caused by vasospasm
that often occurs in the fingers and toes, can also
affect the nipples.
• It occurs in response to cold temperature exposure
abnormal compression of the nipple in the infants
mouth or severe nipple trauma.
Vasospasm may cause nipples to become pale(due to
the lack of blood irrigation ) and often are very
painful
Treatment
• Warm compression can alternative the pain.
• Medications :
Nifidipine (5mg,TID daily for about 1 or 2
weeks or 30mg OD)
Vitamin B6 (200mg/day, OD for about 4 to 5
days and later 50mg/day for another 1 to 2 weeks)
Calcium supplementation(2000mg/day)
Magnesium supplementation(1000mg/day)
Ibuprofen
Breast Complications

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Breast Complications

  • 1. MS.SASIKALA.N MSC (N),OBSTETRICS AND GYNECOLOGICAL NURSING LECTURER GANGA COLLEGE OF NURSING COIMBATORE
  • 3. Content Overview • Introduction • Anatomical variation • Breast complications Breast Engorgement Cracked or Sore nipple Inverted Nipple Nipple Infection Mastitis Breast Abscess Raynaud's Phenomenon
  • 4. Introduction A midwife • Must ensure that the baby is adequately fed at the breast. • Must help the mother to develop necessary skills to feed her baby by herself. • Must know about the different breast conditions which may effect on feeding and many complications which can arise after delivery.
  • 5. Anatomical Variations Abnormally Long Nipple Inverted or Flat Nipple Long Nipple Short Nipple
  • 6. Long Nipple It leads to poor Feeding because the baby is able to latch on to the Nipple without drawing the breast tissue into his mouth
  • 7. Short Nipple It doesn’t cause any problem as the baby has to form a teat from both the Breast and Nipple.
  • 8. Abnormally Large Nipple • In this case, if the baby is small then his/her mouth may not be able to get beyond the nipple and on to the breast. • Lactation should be initiated by expressing.
  • 9. Inverted or Flat Nipple If the nipple is deeply Inverted it is necessary to initiate Lactation be expressing.
  • 10. Breast Complications Breast Engorgement Cracked or Sore nipple Inverted Nipple Nipple Infection Mastitis Breast Abscess Raynaud's Phenomenon
  • 12. Define : Breast Engorgement • It is a condition in which there is a congestion or increased vascularization which leads to accumulation of Milk and edema. • Caused by the Congestion and Obstruction of Lymphatic drainage. ONSET : Usually manifest at 3rd or 4th day of postpartum
  • 13. Mechanism Milk retention in the alveoli causes alveolar distension Duct compression and Milk flow obstruction Deterioration of alveolar distension Increased obstruction Later, edema due to vascular and lymphatic stasis.
  • 14. Symptoms  Pain & Feeling of tenseness  Heaviness in both the breast.  Generalized Malaise  Even Transient Rise of Temperature.  Painful Breast Feeding.  Breast – Feels hard, Edematous and sometimes Flushed.
  • 15. Prevention Start nursing as soon as possible. Avoid pre- lacteal feeds Breast feeding on demand. Initiate breast feeding early and feeding at frequent intervals. Feeding in correct position.
  • 16. Management • If the areola is engorged, manually express some milk before breast feeding.so that the areola gets soft enough for the baby to grasp it properly.
  • 17. Cont.. • Ask the Mother to breastfeed on a regular basis and also on demand. • Massage the breast. • Use systemic Analgesics/Anti inflammatory drugs. • Breast pump if needed. • Advice the mother to wear a well-fitting supportive bra.
  • 18. Cont.. • Apply warm compress to help the ejection of milk. • Apply cold compress after or between to reduce edema, vascualrization and pain. • Application of cabbage leaves on affected breast is very effective intervention in reducing the breast engorgement. • So, education social health activist workers, trained dais and public health nurse who working in community setup.
  • 19. 2. Cracked or sore nipple
  • 20. Normal Nipple The Nipple is not only the structure to deliver milk to the infant, it also contains small, sebaceous gland or Montgomery glands to lubricate the skin of the areola.
  • 21. Define : Cracked Nipple • It is Nipple trauma or Nipple fissure occurs when there is disruption in the skin integrity and the surfaces epithelium is lost. • The crack can appear as a cut across the tip of the nipple and may extend to its base.
  • 22. Causes • Improper positioning and inappropriate latch on. • Short /flat or inverted nipples • Oral dysfunctions in the infant, excessively short frenium • Prolonged non nutritive sucking • Not breaking suction before taking the infant off of the breast • Use of creams and oils that cause allergic reaction on the nipple.
  • 23. Cont.. • Use of nipple shields and prolonged exposure to wet nursing pads. • Improper use of breast pump.
  • 24. Signs and symptoms Pain when the baby lasts longer than 30seconds Crackling Blisters Bleeding and Nipple that are tender between feedings
  • 25. Nursing Management  Encourage the mother to offer the least affected breast first.  Ask the mother to express enough milk before breastfeeding to stimulate the let down reflex, thus preventing the infant from sucking too vigorously on the breast.  Teach mother to alternate between different positions, reducing the pressure on sore areas or on damaged tissues.  Use oral systemic analgesics, if necessary.
  • 26. Cont.. • Apply emollient creams : e.g. lanolin based creams or coconut oil. • This can soften the skin and reduce cracking. • Even breast milk can apply to the nipple this can prevent the cracking and it has antibacterial properties. • Advice the mother to avoid using soaps, deodorants, body powder and other substance which cause allergic reaction that could dry out the nipple.
  • 27. Inverted nipple • An Inverted Nipple is a condition in which the nipple is pulled inward into the breast instead of pointing outward. • Also be called Nipple Inversion, Nipple Retraction or Invaginated Nipple. • Nipple retraction can be congenital as a normal variant in some women. in some case, it may arise as a result of disease or trauma.
  • 28. Causes • Disorder by birth • Due to breast feeding • Pregnancy • Breast infections • Sudden weight loss • Recurrent infections
  • 29. Grades of Inversion Grades Description Grade I A person can easily pull out the nipple, and it maintains its projection. the grade of inversion causes no major problems with breastfeeding. Grade 2 A person can pull the nipple out, but not easily and the nipple tends to retract. they may find it difficult to breastfeed. Grade 3 A person may not be able to pull out their nipple. when pressing the nipple outward.it immediately retracts. Breastfeeding may be very difficult or impossible.
  • 30. Impact on Breastfeeding • That inverted and flat nipples were one of causes, along with many other factors, of delayed onset of Lactation. • Among mothers, first time they have been shown to act as important barriers to weight gain.
  • 32. Nipple infection • Breast infection caused by candida albicans in the puerperium is quite common.infection can be superficial or affect the Lactiferous duct.
  • 33. Treatment • Mother and Infant must be treated simultaneously • Treatment is initially topical Nystatin Clotrimazole Miconazole Ketoconazole for about 2 weeks • This topical can be applied by women after each breast feeding and do not have to remove before the next breastfeeding.
  • 34. Cont.. • Gentian violet 0.5 at 1% can be used on the nipples/areolas and in the mouth of the infant once a day for three to four days. Nursing management • Advice the mother to perform breast care before and after feed. • Ask her to clean the baby’s mouth after feed. • Each her to maintain proper personal hygiene.
  • 35. Mastitis • It is an Inflammatory process of one or more breast segments that may or may not progress into bacterial infections. It usually occurs in the second and third weeks after delivery.
  • 36. Causative organism • Most cases of mastitis result from infection with Staphylococcus areus. Causative factors: • Scheduled feedings • Infants long sleep period at night • Use of pacifiers or bottles. • Failure to completely empty the breast • Short frenulum, infant with a poor suck. • Excessive ,milk production • Separation of mother and infant and abrupt feeding • Maternal fatigue facilitates the development of mastitis
  • 37. Symptoms • Acute onset of Maternal Fever(100 ̊ F or higher) • Malaise and Chills • Myalgia • Breast tenderness associated erythema • It is commonly unilateral. Erythema usually in the upper, outer quadrant with variable degree of induration.
  • 38. Diagnosis • Milk may be expressed from the affected breast for determination of leukocyte. • Culture of the breast milk also may be performed to guide antibiotic therapy.
  • 39. Treatment • Antibiotic therapy • Analgesics, such as ibuprofen or acetaminophen, may be taken for symptomatic relief. Nursing management  Encourage mother for proper emptying of the breast with maintenance of breast feeding.  Manual milk expression after feedings, if necessary despite the presence of bacteria in breast milk in case of mastitis, breastfeeding should be maintained, as if it does not pose any risk to healthy full term infants.
  • 40. Cont.. • Mother should be encouraged to initiate feeds on the unaffected breast and change the infants position at different feeds. • Increased fluid intake and adequate nutrition should be encouraged. • Either cold or warm compress may be used for comfort. • Advice mother to wear non constricting breast support.
  • 41. Breast abscess • Breast abscess develops as a complication of mastitis in 5-11% of women. • Usually occurs in first 12 weeks after birth or at the time of weaning. • It is referred to as puerperal or Lactational abscess.
  • 42. Treatment • Incision and drainage of abscess • Parenteral antibiotics • Fluid from the abscess should be cultured and results used to determine ongoing antibiotic treatment. • Needle aspiration of the abscess repeated every other day until the pus no longer accumulates has been suggested as an alternative open drainage.
  • 44. Raynaud's phenomenon • An Intermittent Ischemia caused by vasospasm that often occurs in the fingers and toes, can also affect the nipples. • It occurs in response to cold temperature exposure abnormal compression of the nipple in the infants mouth or severe nipple trauma.
  • 45. Vasospasm may cause nipples to become pale(due to the lack of blood irrigation ) and often are very painful
  • 46. Treatment • Warm compression can alternative the pain. • Medications : Nifidipine (5mg,TID daily for about 1 or 2 weeks or 30mg OD) Vitamin B6 (200mg/day, OD for about 4 to 5 days and later 50mg/day for another 1 to 2 weeks) Calcium supplementation(2000mg/day) Magnesium supplementation(1000mg/day) Ibuprofen