Breast conditions

1. Breast conditions
After completing this session participants will
be able to recognize and manage these
common breast conditions:
 flat and inverted nipples
 engorgement
 blocked duct and mastitis
 sore nipples and nipple fissure
20/1

2. Both the diagnosis and
management of breast
condition are important in
order to relieve mothers
and enable her to
continue breastfeeding
This is for teaching purposes only. This cannot be published

3. 20/2

4. Different Breast Shapes
 There are different sizes of breast. This is
mostly due to the amount of fat and not to the
amount of tissues that produce milk
 The nipples and areolas also have different
sizes and shapes.
 Sometimes shapes make it difficult for a baby
to get well attached to the breast.
 Babies can breastfeed quite well from breast
of any size, with almost any kind of nipple

5. 20/3
Nipple looks flat Testing protractility of the nipple

6. Points to Remember
 The baby does not suck from the nipple. He
takes the nipple and the breast tissue
underlying the areola into his mouth to form a
“teat”.
 Breast protractility is more important than the
shape of the nipple “stretch the nipple to form
a teat". This improves during pregnancy and
in the first week or so after the baby is born.

7. 20/4

8. 20/4
Inverted nipple

9. Management of flat and
inverted nipples
 Antenatal treatment is not helpful
 Build the mother’s confidence
 Help the mother to position her baby
 If a baby cannot suckle effectively in the first
week or two help his mother to feed with
expressed milk
Page 117 of your participants manual
20/5

10. Syringe Method for the treatment
of Inverted Nipple
1. Put the plunger to the cut end of the barrel
2. Insert plunger from cut end

11.  Put the smooth end of the syringe over
her nipple
 Gently pull the plunger to maintain a
steady but gentle pressure

12.  Do this for 30 sec to one min several
times a day
 Push the plunger back to decrease the
suction ,if she feels pain and when
removing it from the breast

13. 20/6

14. Summary of Difference Between
full and Engorged Breast
Full breast Engorged breast
Hot Painful
Heavy Edematous
Hard Tight, shiny, looks
red
Milk flowing Milk flowing
No fever May be fever for 24
hours

15. Reasons of Engorgement
 Delay in starting breastfeeding
 Poor attachment to the breast so breast milk
is not removed effectively
 Infrequent removal of milk –not on demand
 Restricting the length of breast feeds

16. Treatment of Breast Engorgement
 Do not “rest” the breast
 If baby is able to suckle he should feed
frequently
 If baby can not suckle help his mother to
express her milk
 Before feeding or expressing stimulate the
mothers oxytocin reflex (warm compress,
massage, relax)
 After a feed put a cold compress
 Build the mother’s confidence

17. 20/7

18. 20/7
Red and swollen
fissure

19. Symptoms of blocked duct and
mastitis
blocked duct milk stasis
non-infective
mastitis
infective
mastitis
• Lump
• Tender
• Localised redness
• No fever
• Feels well
• Hard area
• Feels pain
• Red area
• Fever
• Feels ill
Progresses to
20/8

20. Causes of blocked duct and
mastitis
Poor drainage of whole breast:
 infrequent feeds
 short feeds
Poor drainage of part of breast:
 ineffective suckling
 pressure from clothes
 pressure from fingers during feeds
20/9

21. Treatment of blocked duct and
mastitis
 Most important – improve drainage of milk
 Look for cause and correct
 Suggest:
 frequent feeds
 gentle massage towards nipple
 warm compresses
 Start feed on unaffected side; vary position
 Antibiotics in severe symptoms, analgesics,
rest
20/10

22. Treatment of blocked duct and
mastitis
 Start the feed on the unaffected breast
 Blocked duct or mastitis improves within a
day when drainage to the part of the breast
improves
 When severe symptoms or with fissure
mother needs antibiotic treatment
 Management with HIV mothers are different.
Mother must stop breastfeeding and do
expression

23. Antibiotic Treatment for Infective
Mastitis
 The commonest bacterium found in breast abscess is
Staphyloccous aureus
Drugs Dose Instructions
Flucloxacin 250 mgs
orally 6hourly
for 7-10 days
Take dose at
least 30 min
before food
Erythromycin 250-500mgs
orally 6hourly
for 7-10 days
Take dose two
hors after food

24. 20/11

25. 20/11
FISSURE
GOOD OR BAD
POSITIONING
/ATTACHMENT?

26. Management of sore nipples
 Mother should wash breast only once a day
 Medicated lotions and ointments are not
advisable
 After breastfeeding, rub a little expressed
milk over the nipple and areola
The most common cause of sore nipples
is poor attachment.

27. 20/12

28. Candida infection of the breast
Signs and symptoms:
 Skin is sore and itchy. Red ,shiny and flaky
 Burning or stingy sensation (needle prick)
during feeds
 baby have oral thrush

29. Treatment of Candida of the
Breast
 Treatment of both mother and infant with
Nystatin
 Nystatin cream 100,000 IU/g .Apply to nipple
4x daily for 7days after feeds
 Nystatin suspension 100,000 IU/ml. One ml
4x daily for 7 days after feeds or as long
mothers are treated
 Stop using pacifiers, teats and nipple shields