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Breast conditions
After completing this session participants will
be able to recognize and manage these
common breast conditions:
 flat and inverted nipples


 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

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
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
 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.
Inverted nipple 20/4
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
Summary of Difference Between
full and Engorged Breast
Full breast Engorged breast
Hot Painful
Heavy Edematous
Hard Tight, shiny, looks
Milk flowing Milk flowing
No fever May be fever for 24
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
 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

Red and swollen


Symptoms of blocked duct and

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
Causes of blocked duct and
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

Treatment of blocked duct and
 Most important – improve drainage of milk
 Look for cause and correct
 frequent feeds
 gentle massage towards nipple
 warm compresses
 Start feed on unaffected side; vary position
 Antibiotics in severe symptoms, analgesics,
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
 When severe symptoms or with fissure
mother needs antibiotic treatment
 Management with HIV mothers are different.
Mother must stop breastfeeding and do
Antibiotic Treatment for Infective
 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

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
 After breastfeeding, rub a little expressed
milk over the nipple and areola
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
 Treatment of both mother and infant with
 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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