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Breastfeeding and Common Breast Conditions

by Veronica Gillispie, MD, FACOG
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    00:01 Now, let's discuss breastfeeding.

    00:05 So there are several benefits to breastfeeding.

    00:07 Both maternal and fetal.

    00:08 For that reason we do encourage breastfeeding in most situations.

    00:12 There are some indications such as moms are infected with HIV and Hepatitis C.

    00:18 Where breastfeeding is contraindicated.

    00:20 However, in most situation it is definitely encouraged.

    00:23 So let's go through some of those maternal benefits.

    00:26 Weight loss after pregnancy.

    00:28 Decreased unintended pregnancy.

    00:30 As it can sometimes inhibit ovulation.

    00:33 Decreased rates of hypertension and cardiovascular disease in the mom over her lifetime.

    00:37 There's also a decreased rate of breast and ovarian cancer over her lifetime.

    00:42 This is thought to be because during the time of breastfeeding estrogen levels are lower.

    00:47 And without having an ovulation that thought to be protected against ovarian cancer.

    00:54 And then the lower rates of postpartum depression.

    00:56 And this is thought that because of breastfeeding there's an increased bonding between mom and the baby.

    01:02 So fetal benefits.

    01:03 Decreased childhood common illnesses.

    01:06 So through the IgA antibodies when baby breast feeds, he's able to get some antibodies from mom to protect him from different illnesses.

    01:16 Decreased rates of obesity in babies that were breast fed.

    01:18 And again there's increased bonding between mother and infant.

    01:22 So that not only helps mom to decrease the risk of postpartum depression but it also helps infant.

    01:27 And although this is not a completely proven, we think that babies that are breast fed are also cognitively perform better in school.

    01:38 So let's take a case.

    01:40 A 27 year old Para 1 female that delivered a healthy female by vaginal delivery 2 weeks earlier, presents to your office with complaint of bilateral breast pain.

    01:50 She reports the baby has had difficult latch so she is mostly pumping to produce breast milk.

    01:56 She reports a low grade fever.

    01:58 On physical exam both breast are firm and tender with no erythema.

    02:03 What diagnosis best describes this patient's condition? A. Mastitis.

    02:08 B. Engorgement.

    02:09 C. Galactocele.

    02:10 or D. Breast abscess.

    02:12 Well let's talk about some issues that we can have with breastfeeding and see if we can find the answer.

    02:18 So there four common breast conditions that we see with breastfeeding.

    02:22 Engorgement, Mastitis, Galactocele and Breast abscess.

    02:25 With Engorgement, the breast are full of milk and they're just not completely emptying.

    02:31 This can be bilateral.

    02:33 Patients can have a low grade fever.

    02:36 It's common when there is problem with the latch.

    02:39 And treatment is just to increase breastfeeding, warm compression and massage.

    02:44 You are just trying to get those milk ducts to empty.

    02:48 Next is mastitis.

    02:49 Now this is actually an infectious process.

    02:53 Mastitis is usually unilateral.

    02:55 The breast is usually warm.

    02:56 There is erythematous streaking.

    02:59 The most common culprit is Staphylococcus aureus and the treatment is antibiotic.

    03:03 Dicloxacillin as well as continue breastfeeding.

    03:09 The next is Galactocele.

    03:10 So this is a cyst that can form in the breast because of a blocked milk duct.

    03:16 So with the galactocele, there's usually a palpable tender, firm mass.

    03:20 There's no fever because remember it's not infectious.

    03:24 Usually unilateral.

    03:25 And the treatment is the same as Engorgement.

    03:27 Increased breastfeeding, warm compresses and massage.

    03:30 Again you're just trying to get that milk duct to empty.

    03:35 And then finally we can have breast abscess which is actually an infectious process.

    03:41 This is usually unilateral.

    03:42 There's fluctuant mass.

    03:45 Patients can have fever, malaise.

    03:47 And the treatment for this abscess is the same as any abscess.

    03:50 It's incision and drainage followed by antibiotics.

    03:53 So let's go back to our patient.

    03:56 Again she's a 27 year old para 1 female that delivered a healthy female by vaginal delivery 2 weeks earlier.

    04:02 She's coming to your office with complaint of breast pain.

    04:04 She reports the baby had difficult latching.

    04:07 And she is mostly pumping to produce breast milk.

    04:10 She reports a low grade fever.

    04:12 On physical exam both breasts are firm and tender with no erythema.

    04:18 So what do you think is going on with this patient? Is it A. Mastitis.

    04:22 B. Engorgement.

    04:24 C. Galactocele.

    04:27 or the D. Breast abscess.

    04:27 That's right the answer is Engorgement.

    04:31 Remember with Engorgement, is bilateral, such as with our patient.

    04:34 They have low grade fever.

    04:36 That will take out the option of Mastitis as that's usually unilateral.

    04:41 Galactocele remember has no fever.

    04:43 And with Breast abscess, that's also unilateral and there's a fluctuant mass on physical exam.


    About the Lecture

    The lecture Breastfeeding and Common Breast Conditions by Veronica Gillispie, MD, FACOG is from the course Postpartum Care. It contains the following chapters:

    • Breastfeeding
    • Common Breast Conditions

    Included Quiz Questions

    1. Woman with hepatitis C
    2. Woman with mastitis
    3. Woman with a galactocele
    4. Woman with an untreated breast abscess
    5. Woman suffering from bilateral breast engorgement
    1. ...decreased rates of postpartum depression.
    2. ...more difficulty losing weight post-partum.
    3. ...higher lifetime risk of breast cancer.
    4. ...higher risk of unintentional pregnancy.
    5. ...higher lifetime risk of cardiovascular disease
    1. Breast engorgement
    2. Bilateral mastitis
    3. Bilateral galactoceles
    4. Breast abscess
    5. Normal symptoms of breastfeeding
    1. Galactocele, treat with increasing breastfeeding and warm compress
    2. Breast abscess that must be drained
    3. Unilateral mastitis that should be treated with antibiotics
    4. Infected milk duct, treat with drainage and antibiotics
    5. Blocked milk duct, treat by avoiding breastfeeding in the affected breast until the blockage clears
    1. Antibiotic treatment and continue breastfeeding
    2. Drainage of the abscess and antibiotic treatment
    3. Stop breastfeeding while on antibiotic treatment
    4. Stop breastfeeding until engorgement self resolves
    5. Ice packs to reduce engorgement and swelling

    Author of lecture Breastfeeding and Common Breast Conditions

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG


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