Breast Complications

Common breast complications are

1.Breast engorgement

2.Cracked & retracted nipples

3.Mastitis and breast abscess

4.Failing lactation

Breast engorgement

• Due to exaggerated normal venous & lymphatic engorgement preceding lactation, preventing escape of milk from lacteal systm.
• Manifest after the milk secretion- 3rd -4th PPD
• S/S- Pain, feeling of tenseness and heaviness in both breast, malaise, ↑tempt
• Treatment-Support breast with binder & brassiere, ice bag, express milk or frequent breast feeding, analgesic
• Prevention- Manual expression of the remaining milk & frequent breast feedings

Cracked Nipple

• Due to a) loss of surface epithelium, causing a raw area b) fissure at the tip or base of nipple
• Caused by 1)unhygiene –crust over the nipple 2) retracted nipple 3) vigorous suckling
• Asymptomatic usually but if infection, it is painful due to mastitis
• Treatment-keep nipple clean & dry, nipple shield during each feed, rest if worst and feed by expression, antibiotics ( oral & applicant)  and analgesic
• Prevention-Local cleanliness during pregn and puerperium

Retracted nipple

• Primigravida
• If left uncorrected may predispose to cracked nipple- difficulty in breast feeding
• Manual lifting of the retracted nipple during pregnancy is advisable.
• After delivery, use of nipple shield is advisable.

Acute Mastitis

Mode of infection

2 different types of mastitis

• Infection follows a cracked nipple to involve the breast parenchymal tissues leading to cellulites.
• Infection gains access through the lactiferous duct leading to development of primary mammary adenitis
• Responsible organism is Staph aureus- infection comes from nasopharynx of the baby.

Clinical feature

• Symptom- Generalised malaise, headache, fever with chills
• Severe pain and tender, swelling in 1 quadrant of the breast.
• Sign- Wedge shaped swelling on the breast with the apex at the nipple
•  Over lying skin is hot, flushed, tense and tender

Treatment

• Antibiotics- Cloxacillin, Cefalosporin
• Analgesic 
• Antenatal-Wash the nipple periodically to keep the patency of the duct opening.
•  Breast feeding on the affected is suspended
• Manual expression & prevention of engorgement of breast.

Breast Abscess

• Swinging tempt
• Reddened breast
• Marked tenderness with fluctuation.

Treatment

• Antibiotics
• Incision and drainage

Wound infection

• Wound can be that of a CS or an episiotomy wound
• Infection in the wound usually develops around the 5th to 6th POD
• Take Swab from the wound and send for C/S 
• Treat with antibiotics and daily dressing
• Followed by secondary suture,

Chest infections

• Usually following general anaesthesia in CS
• Take x-ray chest and sputum for C/S
• Treatment is with physiotherapy, warm saline gurgle, steam inhalation and antibiotics

Deep Vein Thrombosis (DVT)

• Usually occurs at around 7-10th PPD
• Begins in the deep veins of the calf or soles of the feet and extend upwards
• Often symptomless
• Sharp dorsiflexion of the foot elicit pain in the calf-Homan’s sign
• Slight rise of tempt & pulse.
• These early S/S may be missed and detected only when pulmonary embolism has developed or when the generalised oedema of the leg has set.
• Exercise in early puerperium is beneficial.
• The foot end of the bed is elevated to increase the venous flow from the leg.
• Antibiotics to prevent infection
• Anticoagulant to prevent clot formation-Heparin.
• After being afebrile the pt is encouraged to walk about with the affected leg supported by elastic bandage.

Gynaecology Centre-Nairobi