Breastfeeding and Common Breast Conditions

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 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.