Breast Complications

postnatal complications, breast disorders

1. BREAST
COMPLICATIONS
R. Kavitha
Asso. Prof,KCN

2. BREASTCOMPLICATIONS
The common breast complications in puerperium
are:
(1)breastengorgement,
(2)cracked and retracted nipple leadingto
difficulty inbreastfeeding,
(3)mastitis and breastabscess,
(4)lactationfailure.
•Breast engorgement and infectionare
responsible for puerperalpyrexia.

3. Definition
Breast engorgement occurs in the mammary
glandsdue to expansion and pressure exerted by
the synthesis and storage of breast milk. It is also
a main factor in altering the ability of the infant to
latch-on. The nipples on an engorged breast are
flat orinverted.

4. Cause:
•Breast engorgement is due to exaggerated
normal venous and lymphatic engorgement of
the breasts which precedeslactation.
•prevents escape of milk from the lactealsystem.
•The primiparous & inelastic breasts are likely to
beinvolved.
•Engorgement is an indication that the baby isnot
in step with the stage oflactation.

5. Signs &Symptoms
•Considerablepain
•feeling oftenseness
•heaviness in both thebreasts,
•Generalizedmalaise
•even transient rise oftemperature
•Painfulbreastfeeding.

6. Prevention
(i)To avoid prelactealfeeds
(ii)To initiate breastfeeding early and
unrestricted,
(iii)exclusive breastfeeding ondemand,
(iv)Feeding in correctposition,
(v)Correct latch onbreast.

7. Treatment:
(1)To support the breasts with a binder orbrassiere,
(2)Frequentsuckling,
(3)Manual expression of any remaining milk aftereach
feed,
(4)To administer analgesics forpain,
(5)The baby should be put to the breast regularlyat
frequentintervals,
(6)In a severe case, gentle use of a breast pump may be
helpful. This will reduce the tension in the breast without
causing excess milkproduction.

8. CRACKED AND RETRACTED
NIPPLE
•Cracked nipple (nippletrauma
or nipple fissure) is a condition that can
occur in breastfeedingwomen.
•A retracted nipple is a nipple that
turns inward instead of outward,except
whenstimulated.

9. causes
a)unclean hygiene resulting in formation of
a crust over thenipple,
b)retractednipple,
c)Trauma from baby’s mouth due to
incorrect attachment to thebreast,
d)infection with Candida albicans and S.
aureus is oftenpresent.

10. Signs &symptom
•redness.
•soreness.
•chafed, dryappearance.
•crustiness orscabbing.
•oozing.
•bleeding.
•open cracks orsores.
•pain ordiscomfort.

11. Management
Prophylaxis:
•local cleanliness during pregnancy and in
the puerperium before and after each
breastfeeding to prevent crust formation
over thenipple.

12. Treatment:
•Correct attachment (latch on) will provide immediate
relief from pain and rapidhealing.
•Fresh human milk and saliva have gothealing
properties.
•Purified lanolin with the mother’s milk is applied threeor
four times a day to hastenhealing.
•When it issevere:
•mother should use a breast pump and the infant isfed
with the expressedmilk.
•Inflamed nipple and areola may be due to thrushalso.

13. Cont…
•Miconazole lotion is applied over the nipple as
well as in the baby’s mouth if there is oralthrush.
•If it fails to heal up, rest is given to theaffected
nipple using a breast pump while the nipples
heal.
•Nipple shields (thin latex) can be used. The
persistence of a nipple ulcer, inspite of therapy
mentioned, needs biopsy to excludemalignancy.

14. Retracted and flat nipple:
•It is commonly met in primigravidae. It is
usuallyacquired.
•Babies are able to attach to the breast
correctly and are able to suckadequately.
•In difficult cases, manual expressionof
milk can initiatelactation.
•Gradually breast tissue becomes softand
more protractile, so that feeding is
possible

15. AcuteMastitis
Acute mastitis isusually
a bacterial infection and is seenmost
commonly in the postpartumperiod.
Bacteria invade the breast through the small
erosions in the nipple of a lactating woman,
and an abscess canresult.
Chronic mastitis can be a sequela of acute
mastitis, or more commonly, associated
with ductectasia.

16. incidence
•mastitis is 2–5% in lactating and less than
1% in non-lactatingwomen.

17. Clinicalfeatures:
•Generalizedmalaise
•headache,
•nausea,
•vomiting,
•Fever (102°F or more) withchills,
•Severepain
•tender swelling in one quadrant of thebreast.
•The overlying skin isred,
•hot andflushed

18. Diagnosis:
•Microscopic examination of breast milk,
showing leucocytes more than 106/mL
and bacterial count more than 103/mL,
supports the diagnosis ofmastitis.

19. Complications:
•Duetovariabledestructionofbreast
tissues,itleadstotheformationofa
breastabscess.

20. PROPHYLAXIS:
•Thorough hand washing before each feed,
cleaning the nipples before and after each
feed, and keeping them dry, reduce the
nosocomial infectionrates.

21. Management
a)Breastsupport,
b)Plenty of oralfluids,
c)Breastfeeding is continued with good attachment. Nursing is
initiatedontheuninfectedsidefirsttoestablishletdown,The
infected side is emptied manually with eachfeed,
d)Dicloxacillin (penicillinase-resistant penicillin) is the drug of choice.
A dose of 500 mg every 6 hours orally is started till the sensitivity
report available. Erythromycin is an alternative to patients who are
allergic to penicillin. Antibiotic therapy is continued for at least 7
days,
e)Analgesics (ibuprofen) are given forpain,
f)Milk flow is maintained by breastfeeding the infant. Thisprevents
proliferation of Staphylococcus in the stagnantmilk.

22. BREASTABSCESS:
Clinical Featuresare:—
a)Flushed breasts not respondingto
antibioticspromptly
b)Brawny edema of the overlyingskin
c)Marked tenderness withfluctuation,
d)Swingingtemperature.

23. prophylaxis
•Breastfeeding is continued in the uninvolved
side. The infected breast is mechanically
pumped every 2 hours and with every let down.
Recurrence risk is about 10%. Once cellulitis
has resolved, breastfeeding from the involved
side may beresumed.
•Antibiotics to be continued depending uponthe
culture report ofpus.

24. Management:
•Appropriate nursing technique, positioning
and breast care can reduce pain
significantly, when it is due to nipple
trauma, engorgement ormastitis.
•Useofmiconazoleorallotionorgelinto
boththenipplesandintoinfant’smouth
thricedailyfor2weeksishelpful.

25. Lactationfailure
Causes are:
1)Infrequentsuckling,
2)Depression or anxiety state in thepuerperium,
3)Reluctance or apprehension to nursing,
4)Painful breastlesion,
5)Endogenous suppression of prolactin (retained
placentalbits),
6)Prolactininhibition

26. Treatment:
•For maintenance of effective lactation inan
otherwise healthy individual, the following
guidelines are helpful.
•Antenatal:
(1)To counsel the mother regarding the
advantages of nursing her baby with breastmilk,
(2)To take care of any breast abnormality
especially a retracted nipple and to maintain
adequate breast hygiene especially in the last2
months ofpregnancy.

27. Puerperium:
•To encourage adequate fluidintake,
•To nurse the babyregularly,
•Painful local lesion is to be treated toprevent
development of nursingphobia,
•Metoclopramide, oxytocin and sulpiride (selective
dopamine antagonist) have been found to increasemilk
production.
•They act by stimulating prolactin secretion.
Metoclopramide given in a dose of 10 mg thrice daily is
foundhelpful.