The document discusses various breast complications that may arise after delivery, including breast engorgement, cracked nipples, mastitis, breast abscess, and lactation failure, along with their prevention and management strategies. Symptoms, treatment options, and recommendations for maintaining breastfeeding are also outlined. Emphasis is placed on proper breastfeeding techniques, hygiene, and timely medical intervention for complications.

1. Breast problems after
delivery and its management
Sunil Kumar Daha

2.  Breast complications in puerperium
1. Breast engorgement
2. Cracked and retracted nipple
3. Mastitis
4. Breast abscess
5. Lactation failure

3. Breast Engorgement
Common in primiparous and patient with inelastic breasts
Onset: 3 to 5 days after delivery (if do not breast feed)
exaggerated normal venous and lymphatic engorgement of breast which precede
lactation
Prevents the escape of milk from lacteal system

4. Symptoms
Considerable pain and feeling of heaviness in both the breasts
Generalized malaise or even transient rise of temperature and
Painful breast feeding.

5. Prevention
 Avoid prelacteal feeds
 Initiate breast feeding early and unrestricted
Exclusive breast feeding on demand,
 Feeding in correct position

6. Treatment
 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
In a severe case gentle use of a breast pump may be helpful.

7. Cracked nipple
The nipple may be painful due to:
Loss of surface epithelium
Due to a fissure situated at tip or base of nipple or at both area
 Causes:
Poor hygiene  formation of crust over the nipple
Retracted nipple
Trauma from baby’s mouth due to incorrect attachment to mother’s breast
Infection with candida albicans and S. aureus
*Condition may be asymptomatic but becomes painful when the infant sucks the breast

8. Prophylaxis
Local cleanliness during pregnancy and puerperium, before and after each
breastfeeding to prevent crust formation in the nipple
Treatment
Latch on will provide immediate relief from pain and rapid healing
Purified lanonin with mother’s milk applied 3-4 times a day to hasten healing
*Fresh human milk and saliva have got healing properties

9. Treatment cotd…
Miconazole lotion applied over nipple as well as in the baby’s mouth (if there
is oral thrush).
If fails to heal, rest is given to affected nipple using breast pump while the
nipple heals.
*Biopsy is needed to exclude malignancy, if nipple ulcer persists in spite of above therapy

10. Retracted and flat nipple
Common in primigravidae
Babies can attach and are able to suck adequately
If unable to suck, manual expression of milk and fed

11. Acute Mastitis
incidence:
2-5% in Lactating mothers
<1% in non-lactating mothers
Organisms involved:
Staphylococcus aureus
Staphylococcus epidermidis
Viridans streptococci

12. Risk factors
Poor nursing
Maternal fatigue and cracked nipple
Types of mastitis (based upon site of infection)
Infection in breast parenchymal tissue cellulitis
Infection in lactiferous ducts primary mammilary adenitis
Non-infective mastitis due to milk stasis

13. Clinical features
Symptoms:
Generalized malaise and headache, nausea, vomiting
 Fever (102°F or more) with chills
Severe pain and tender swelling in one quadrant of the breast
Signs include
toxic features
swelling on the breast
 The overlying skin- red, hot and flushed and feels tense and tender.

14. Management
Breast support
Plenty of oral fluids
Continued breastfeeding in the unaffected side
Infected side manually emptied
Dicloxacillin is drug of choice 500 mg 6 hourly for 7 days
Erythromycin is alternative to the people allergic to penicillin
Analgesics for pain *Breast feeding maintains flow- prevents proliferation of staphylococcus
in the stagnant milk

15. Prophylaxis
Hand wash before each feed
Clean nipple before and after each feed with mild soap
Keep nipple dry
Complications
breast abscess due to variable destruction of breast tissues

16. Breast Abscess
Clinical features
Flushed breast not responding to antibiotics promptly
Edema of overlying skin
Marked tenderness with fluctuation
Swinging temperature
Breast pain : due to engorgement, infection (Candida albicans)
nipple trauma, mastitis or occasionally with let down reflex

17. Management:
Surgical draining of abscess (Incision and drainage under general anesthesia)
Breast feeding is continued from uninvolved side
Infected breast is mechanically pumped every 2 hours and with every let
down

18. Lactation failure
Inadequate milk production
Causes:
Infrequent suckling
Depression or anxiety state in puerperium
Reluctant or apprehension to nursing
Ill development of nipples
Painful breast lesions
Endogenous suppression of prolactin(retained placental bits)
Prolactin inhibition(pyridoxine, ergot preparation, diuretics)

19. Treatment guidelines
Antenatal
Counsel mother
Take care of breast abnormalities (retracted nipples)
Puerperium
Encourage adequate fluid intake
Nurse baby regularly
Treat painful local lesions
Selective dopamine antagonist (Metoclopramide 10mg TDS Po)

20. References
• Konar.H, DC Dutta’s Textbook of obstetrics 8th edition, Jaypee
publication
• Cunningham ,Bloom, Spong,Dashe,Hoffan,Casey,Sheffield,
Williams obstetrics,24th edition ,Mc Graw Hill education

21. Thank You