Breast Engorgement 34216m

Breast Engorgement Ivan Kurniadi 0906644852

Anatomy

Postpartum Engorgement • Occurs due build-up of milk in the breast • Feels heavy, warm, and uncomfortable • >>> milk  exceeds the alveoli capacity  occlude the capillary circulation  fluid leaks out  edema • This will also obstruct the lymph vessels and stagnating the system that rid the breasts of toxins, bacteria • Management – – – –

Breastfeed frequently Breast massage Compress with cold packs Analgesia if pain is very severe

Mastitis • Lactational / Puerperal • Non-lactational

Lactational Mastitis • Mostly happens in the first 2-3 weeks post partum although can happen anytime • Mainly caused by unsecreted breast milk due to: – Ductal obstruction – Inadequate breastfeeding frequency and length – Inadequate suckling – Excessive breast milk production

• Unsecreted breastmilk  bacterial growth • Infection can be hematogenous or through lymphatic system • Predisposing factors: – Age  21-35 y.o. – 1st child – History of mastitis – Labor complications  delayed breastmilk excretion

– Nutrition  patients with high fat and high salt diet and anemia. Antioxidant, selenium, vitamin A & E reduces risk – Stress and fatigue – Active mother  static breastmilk – Trauma

• Clinical presentation – Heavy, warm, edematous, and painful breast – Spontaneous breastmilk secretion or difficulty in secreting breastmilk – Ductal obstruction  galactocele (breastmilkmilled cycts) – Subclinical mastitis  increase of Na/K ratio and elevation of IL-8 in the breastmilk without symptoms of mastitis  inflammation response

– Infectious mastitis – Recurrent mastitis  inadequate management of previous mastitis – Breast abscess  redness, painful, warm, and edematous breast and surrounding tissue

• Prevention – Proper breastfeeding – Prompt treatment if symptoms of obstruction are found

• Complications of improper treatment: – Abscess – Recurrent mastitis – Secondary infection

• Management – ive counseling  do not stop breastfeeding – Antibiotic • Cephalexin / dicloxacilin 4x500 mg • Eryhtromycin 4x500 mg

– Symptomatic  analgesic, rest, compress – Abscess  incision, drainage , and proper antibiotic

Non-lactational Mastitis • Periareolar infection – Infection of subaerolar ducts, occurs mostly in young women and is strongly associated with smoking (90%)

• Cellulitis with/without abscess – Infection affecting the dermis and subcutaneous fat and is correlated with infected trauma

• Mammary duct fistula – the abscess cavity drains onto the breast surface, leaving a connection from the skin into the breast tissue that continually drains purulent material.

• Peripheral nonlactational breast abscess – Associated with comobrids such as DM, trauma, steroid therapy, and arthritis

• TB – Spread of M. tuberculosis via the axilla, neck, or mediastinum lymph node

• Factitial abscess – When abscess remains or recurrent despite adequately treated, commonly occurs in psychiatric patients

Reference • Sarwono Prawirohardjo. Ilmu Kebidanan. Edisi 4. 2014. Jakarta: Bina Pustaka Sarwono Prawirohadrjo. p. 375-9 • Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams Obstetrics: 23rd Edition: 23rd Edition: McGraw-Hill Education; 2009.