20/1

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

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

20/2
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
 20/3
Nipple looks flat Testing protractility of the nipple
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.
20/4
Inverted nipple 20/4
 20/5
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
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

Put the smooth end of the syringe over
her nipple

Gently pull the plunger to maintain a
steady but gentle pressure

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
20/6
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
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
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
20/7
 20/7

Red and swollen

fissure
 20/8

Symptoms of blocked duct and

mastitis
non-infective infective
blocked duct milk stasis
mastitis mastitis

• Lump • Hard area

• Tender Progresses to • Feels pain
• Localised redness • Red area
• No fever • Fever
• Feels well • Feels ill
 20/9
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

 20/10
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
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
Antibiotic Treatment for Infective
Mastitis

The commonest bacterium found in breast abscess is
Staphyloccous aureus

Drugs Dose Instructions

Flucloxacin 250 mgs Take dose at
orally 6hourly least 30 min
for 7-10 days before food

Erythromycin 250-500mgs Take dose two

orally 6hourly hors after food
for 7-10 days
20/11
 20/11
GOOD OR BAD
POSITIONING
/ATTACHMENT?

FISSURE
Management of sore nipples
The most common cause of sore nipples
is poor attachment.

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
20/12
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
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
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