Breast problems after

delivery and its management

Mrs. Shwetha Rani C.M.

Associate Professor & H.O.D.
Department of Obstetric & Gynecological Nursing
SCPM College Of Nursing & Paramedical Sciences,
Gonda. U.P.
Breast complications in puerperium
1. Breast engorgement
2. Cracked and retracted nipple
3. Mastitis
4. Breast abscess
5. Lactation failure
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

Symptoms

• Considerable pain and feeling of heaviness in both the breasts

• Generalized malaise or even transient rise of temperature and
• Painful breast feeding.
Prevention
• Avoid prelacteal feeds
• Initiate breast feeding early and unrestricted
• Exclusive breast feeding on demand,
• Feeding in correct position
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.
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
• 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

• 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
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
Acute Mastitis

➢incidence:
• 2-5% in Lactating mothers
• <1% in non-lactating mothers
➢Organisms involved:
• Staphylococcus aureus
• Staphylococcus epidermidis
• Viridans streptococci
• 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

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.
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
• 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
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
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
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)
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)