Breast Problems

Breast Problems: Includes Breast engorgement, Mastitis, Breast Cancer, Breast reconstruction, Breast feeding, & Mastectomy.

We will also discuss Breast self examination

Breast Engorgement & Mastitis

Mastitis:Parenchymatous inflammation of the mammary glands

Breast engorgement: Congestion

Mastitis and breast engorgement are disorders that may affect lactating females.  Mastitis occurs in about 1% of postpartum patients, usually primiparas (a woman who has had one pregnancy that resulted in a viable young) who is breast feeding.  It may also occur in nonlactating females and rarely in males.

All breast-feeding moms develop some degree of engorgement, but it is especially likely to be more severe in primiparas.

Cause:  Mastitis may develop when a pathogen that typically originates in the nursing infant's nose or pharynx invades breast tissue through a fissured or cracked nipple and interferes with normal lactation.  The most common pathogen is Staphylococcus aureus.  Rarely, mastitis may result from disseminated tuberculosis or the mumps virus.

Predisposing factors include a fissure or abrasion of the nipple; blocked milk ducts; and an incomplete let-down reflex, usually resulting from emotional trauma.  Blocked mild ducts can result from a tight bra or prolonged intervals between breast-feedings.

The cause for breast engorgement include venous  and lymphatic stasis, and alveolar milk accumulation.

Symptoms:

Mastitis may develop anytime during lactation but normally begins 3 to 4 weeks postpartum.
Fever 101 degrees F. or higher
Malaise
Flu-like symptoms
Breast may be tender, hard, swollen, and warm
Must be treated adequately, or it may progress to breast abscess

Breast engorgement usually starts with onset of lactation

The breast undergo some changes similar to those of mastitis, and body temperature may be elevated.

Engorgement may be mild to severe.  Mild case cause only slight discomfort, while severe cases cause considerable pain. (a severely engorged breast can interfere with the neonate's capacity to feed because of his inability to position his mouth properly on the swollen rigid breast.

Treatment:

Mastitis:  Antibiotic therapy (although symptoms usually subside 2 to 3 days after treatment begins, but do not stop antibiotic therapy, it should be continue as prescribed by your doctor - usually 10 days treatment)  When antibiotic fails (though rare) to control the infection and mastitis progresses to breast abscess, incision and drainage of the abscess may be done.

Analgesics may be prescribed for pain

Breast engorgement:  goal is to relieve discomfort and control swelling.
Your doctor may prescribed analgesics to alleviate pain
Ice packs and uplift support to minimize edema.
Oxytocin nasal spray may be prescribed (rarely) to release mild from the alveoli into the ducts.

To facilitate breast-feeding, the mother may manually express excess milk before a feeding so the baby can grasp the nipple properly.

Breast-Feeding

Breast-feeding:  Breast milk contains a unique balance of nutrients, it's considered the ideal food for infants.  What's more, the maternal antibodies it  contains help protect the infant against allergy and infection.

The U.S. Surgeon General and the American Academy of Pediatrics recommend breast-feeding for at least the first 6 months of life.  Breast mild contains the perfect balance of carbohydrates, proteins, and fats.  It is easily digestible.  It provides a rich source of linoleic acid (an essential fatty acid), and it contains immune factors that protect infants from infection.  Breast-feeding right after birth helps the uterus contract and return to its former size and position.

Breast-feeding has some drawbacks, because newborns require feeding every 2 to 4 hours (called: demand feeding) and the mother is the only source of milk.  The mom will have to change her routine and interrupt her sleep to accommodate the infant's schedule. (as infant grows, and sleep patterns is develop, feeding time is not as frequent).  Mom's don't be afraid to ask for help, if you have other children, have them help with chores.  Rest when your infant is sleeping.  Remember as your infant grows and begins to eat solid food, he will require fewer breast -feeding but will consume more milk at each feeding.

Getting ready to breast-feed:  First- Always wash your hands. Second- wash your nibble with a warm clean washcloth (don't use soap). Third- Relax.  Start by making yourself comfortable.

Sit with your back straight or lightly bent forward. (You can support your back with a pillow, or put a pillow on your lap to raise your infant to breast level.)

If you had a cesarean section:  you may want to try laying on your side to relieve pressure on your suture line (this allows you to support your infant with your lower arm.)

Feeding your baby:  Rest  your baby's head in the crook of your elbow and support his back with your hand (always support the baby's head)

Then turn the baby's body (not just the head) towards you, and to cup your breast with your other hand (fingers under, thumb above).

Next:  Touch your baby's cheek nearest you to make your baby's turn his head, and then, touch your nipple to his mouth to stimulate his rooting and sucking reflexes. (he will smell your milk and open his mouth).

When he does, insert your nipple and areola (the dark area around the nipple) in his mouth, so that the tip of his nose touches the top of your breast (it may look like he can't breath but he can).  Make sure your entire areola is in his mouth, otherwise, his sucking will be ineffective for him and it can be very painful for you.

Let the baby feed from both breast at every feeding.  You should start from 2 to 5 minutes for each breast, then 10 to 15 minutes regularly. Remember to burp the baby after he finishes feeding from each breast.

How to break suction:  when the baby has finished feeding, gently pull his chin down or gently insert a finger into the corner of his mouth to break the suction and release the nipple. (don't simply pull free, it can be very painful and can cause sore nipples).  Although your baby dictates the breast -feeding schedule, there is flexibility, for example:  you can occasionally give a bottle of formula when breast -feeding isn't convenient, or you can express your milk by hand or with a breast pump and refrigerate it for later use (do not microwave breast milk - it will lose it's immune nutrient- heat by putting the bottle into a very hot pan of water and always check temperature of milk by putting a drop or two on top of your wrist - it should not be hot).

Care of breast and nipple:  It is best to air dry your nipples after you have finished breast -feeding or after expressing milk.  Wear a nursing bra that support and is comfortable.  Wear a nursing pad or a soft cloth in your bra (more likely, your breast milk will leak.)

Storing breast milk:  Refrigerated milk must be used within 24 hours, and frozen milk must be used within a few weeks.  Thaw frozen milk under lukewarm tap water and to use it within 3 hours (do not thaw frozen milk in the microwave oven, and never refreeze it)

Patient teaching:  When breast-feeding, you need adequate sleep, have  a good well balance nutritional diet, drink plenty of water (8 oz. water at least 8 times daily) Avoid alcohol, excessive caffeine, and over the counter medications (ask your doctor in regards to medications)

Many hospitals encourage mothers to breast-feed within 2 hours after birth because early and frequent feedings may help decrease breast engorgement and promote successful breast-feeding. (Breast-feeding may have to be postponed or interrupted in the hospital if the baby is premature or has jaundice.)  Also keep in mind that breast-feeding may have to stop temporarily if you develop a generalized infection.

Many women don't menstruate while they're breast-feeding but that breast-feeding shouldn't be used as birth control.  Pregnancy can still occur, so take precautions.

Remember:  breast feeding is a matter of choice, it is also common and your baby still will get the complete nutrient if you choose to bottle feed.  No matter what you choose whether you choose breast-feed or bottle-feed, mother and baby will still have the emotional satisfaction and bonding that is beautiful and fulfilling.

Breast Reconstruction

Learn the facts and symptoms of Breast cancer

Breast Reconstruction or Reconstruction mammoplasty:  can help relieve the emotional distress caused by mastectomy.  As a result, it can improve the patient's self-image and restore her sexual identify.

Breast reconstruction isn't for every mastectomy patient.  For instance, it's contraindicated when metastasis is possible, if healing is impaired, or if the patient has unrealistic expectations.  Even when breast reconstruction is feasible, some women choose not to undergo it.  They're comfortable, active, and well adjusted without it.  Or they may not consider the burden of additional surgery, anesthesia, pain, or expense worthwhile.

How it's done:  In breast reconstruction, the surgeon places an implant filled with silicone or saline solution under the skin.  He may bank the patient's own nipple on her inner thigh or inguinal area and salvage it at the appropriate time.  (Its color may darken in the immediate postoperative period, but this should fade)  Or the surgeon may reconstruct a nipple from labial tissue.

This is a matter of choice, you may want to contact the local chapter of the American Cancer Society for any additional information, and you may also want to talk to someone from the Reach to Recovery program.

Mastectomy

Mastectomy: This procedure removes malignant breast tissue and any regional lymphatic metastases and often works in combination with radiation therapy and chemotherapy.  There are six different types of mastectomy, depending on the size of the tumor and the presence of any metastases.

Partial mastectomy:  also called a lumpectomy, typlectomy, or segmental resection.  Usually done for Stage 1 lesions.  This approach leaves a cosmetically satisfactory breast but may fail to remove all malignant tissue or to detect metastases in axillary lymph nodes.

Subcutaneous mastectomy:  treats patients with a central, noninvasive tumor, chronic cystic mastitis, multiple fibroadenomas, or hyperplastic duct changes.

Simple mastectomy:  if a tumor is confined to breast tissue, the surgeon may perform a simple mastectomy.  It's also used palliatively for advanced, ulcerative malignancy and as treatment for extensive benign disease.

Modified radical mastectomy:  This is usually the standard surgery for Stage1 and Stage11 lesions, to remover small, localized tumors.  Besides causing less disfigurement than a radical mastectomy (which was the treatment of choice until recently), it also reduces postoperative arm edema and shoulder problems.

Radical mastectomy:  controls the spread of larger, metastatic lesions.  Later, the surgeon may perform breast reconstruction, using a portion of the latissimus dorsi.

Extended radical mastectomy:  Rarely, this procedure may treat malignancy in the medial quadrant of the breast or in subareolar tissue.  It prevents possible metastasis to the internal mammary lymph nodes.

In any type of mastectomy, infection and delayed healing can result.  The major complication of radical mastectomy and axillary dissection is lymphedema, occurring soon after surgery and persisting for years.  Dissection of the lymph nodes draining the axilla may interfere with lymphatic drainage of the arm of the affected side.

Home Care Instructions:  Prevention of lymphedema (chronic swelling of a part due to accumulation of interstitial fluid (edema) secondary to obstruction of lymphatic vessels or lymph nodes).  Swelling may follow even minor trauma to the arm on the affected side.

Wash cuts and scrapes on the affected side promptly and to contact your doctor immediately if it becomes red, with edema, or induration occurs.

Use the arm as much as possible and to avoid keeping it in a dependent position for a prolonged period.

Range of motion exercise daily is important (do it with both arms to maintain symmetry and prevent additional deformities)

Do not allow any blood pressure readings, injections, or venipunctures to be performed on the affected arm.

Keep postoperative appointments

Monthly self-examination of the remaining breast and the mastectomy site is important (report any unusual lumps)

The patient energy level will wax and wane, be alert of signs of fatigue and to rest frequently during the day for at least the first few weeks after discharge.

There are permanent prosthesis that can be discuss with your doctor (it can be fitted 3 to 4 weeks after surgery)

Breast Self-Examination

Breast self-examination:  Because 90% of breast cancers are discovered by women themselves, it is important that patients do their own monthly self-examination.  The best time for this examination is immediately after your menstrual period. (if patient hasn't reached menopause).  If past menopause, you can examine your breast at any time.

Standing before a mirror:

Step 1. Undress to the waist, stand in front of a mirror, with your arms at your sides.  Observe your breast for any change in their shape or size and any puckering or dimpling of the skin.

Step 2. Raise your arms and press your hands together behind your head.  Observe as you did in step 1.

Step 3. Press your palms firmly on your hips.  Observed your breast again.

Lying down:   Step 1.   Examine your breast while lying flat on your back.  This will flatten and spread your breasts more evenly over the chest wall.  Place a small pillow under your left shoulder, and put your left hand behind your head

Step 2.  Examine your left breast with your right hand, using a circular motion and progressing clockwise, until you have examined every portion. (you  will notice a ridge of firm tissue in the lower curve of your breast, which is normal)  Check the area under your arm with your elbow slightly bent. (don't be alarmed if you feel a small lump under your armpit that moves freely; this area contains lymph glands, which may become swollen when you are ill)  Check the lump daily, and call a doctor if it doesn't go away in a few days or if it gets larger.

Step 3.  Gently squeeze the nipple between your thumb and forefinger, and note any discharge.  Repeat this examination on the right breast, using your left hand.

In the shower:  You can examine your breast while in the shower or bath, after first lubricating them with soap and water.  Using the same circular, clockwise motion, you should gently inspect both breasts with your fingertips.  After you have toweled dry, you should squeeze each nipple gently, noting any discharge.

What to do about lumps:  First, don't panic if you feel a lump while examining your breasts.  Most lumps aren't cancerous.  See if you can easily lift the skin covering it and whether the lump moves when you do so.

Notify your doctor if you notice any change, discharge, and or lump.  He will want to examine it and then tell you if you need further tests and or treatment.

Although self-examination is important, it is not a substitute for examination by your doctor .  See your doctor annually or semiannually, if you are considered at special risk.

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