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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

 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
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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
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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.
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Inverted nipple 20/4
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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
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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
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Red and swollen

fissure
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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
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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
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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
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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
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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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