Mammary gland diseases in the postpartum period and their management

This is an automatically translated article.

The article was written by Specialist Doctor II Nguyen Dinh Toi - Obstetrics Department - Vinmec Times City International Hospital

Postpartum is the period to return to normal anatomical and physiological sex organs (except for the mammary glands, which continue to develop to produce milk). There was a study in a hospital in the city of Ponta Grossa Parana 2015, on 252 women in the first 10 days of postpartum period hospitalized in the obstetrics and gynecology department, 153 (53.5%) had nipple cracks of various sizes. fissures were different and 24 (9.2%) postpartum women had bilateral lactation.

I: Inverted nipple

1.What is nipple indentation? Causes and treatment? Nipple inversion is a phenomenon in which part or all of the nipple is retracted, affecting the function and aesthetic appearance of the areola structure. According to a study conducted by Sanuki J in 2009, 3.5% of women have inverted nipples.
1.1 Causes of nipple retraction Nipple reduction is mainly due to the shortening of the ducts, hypoplasia and the lack of connective tissue of the mammary glands; some are due to atrophy of mammary glands and mammary gland connective tissue after birth. However, it also does not exclude cases of inflammation, mammary gland tumors causing contraction and shortening of the mammary ducts. Therefore, with cases of nipple inversion, it is necessary to be examined to exclude cases of infection and mammary gland tumors before handling.
1.2 Clinical grade The grade of nipple inversion was given by Han S and Hong YG, dividing this condition into 3 levels as shown.

1.3 Treatment goals for inverted nipples 2. Treatments for inverted nipples It should be noted for mothers that breastfeeding will help nipples to protrude, especially 1-2 weeks after giving birth. suckling, when the nipple has become softer. Besides, there are other methods to support this condition:
2.1 Using a suction device or a syringe Mother can use a suction pump sold in the market or cut the syringe to use if it is not possible to use a pump. suck. Note that it is necessary to cut the syringe body towards the needle tip, then pull out the pistol and push it back to the newly cut side so that the contact area does not hurt the mother's breast.
2.2. Changing the feeding position Normally when holding a nursing baby, the mother will move the baby's legs to the left side if sucking on the right breast and vice versa. In the case of inverted nipples, you can change position by bringing the baby's feet towards the nursing side to help the nipple protrude.
2.3 Support the nipple This is also a method to make it easier for the baby to suckle, contributing to helping the nipple return to its normal shape. The mother needs to use her hand to support the nipple so that the nipple can be most convenient for the baby. In severe cases, it is possible to intervene by plastic surgery for the nipple.

II. Cracked nipples

1.What is cracked nipple? Causes and treatment? Cracked nipples are very common, especially within the first 30 days after giving birth. According to research by Kamila Juliana da Silva Santos in 2016, 32% of women experience cracked nipples during this time. Cracked nipples lead to difficulty in breastfeeding and premature termination of breastfeeding.
2. Causes of cracked nipples Factors associated with this condition include:

3. Prevention of cracked nipples Avoid washing with soap or harsh rubbing on the nipples that cause cracked nipples. Rub some milk on your nipples after feeding for protection. Do not leave the nipple wet for a long time to cause infection. 4. Treatment of cracked nipples Nipple cracks can be treated by applying Lanolin to the nipples. Glycerin patches can also be used to soothe pain and aid in wound healing. If the cause is fungal it is usually treated with nystatin. It is important to continue to breastfeed your baby as this helps in better healing of the fissure.

III. Mastitis

1.What is mastitis? Causes, risk factors, symptoms and treatment? 1.1 Causes - Risk factors Postpartum mastitis occurs in about 2-10% of breastfeeding women.
Postpartum mastitis is the result of prolonged stagnant milk. Normal milk is not a sterile suspension. These bacteria belong to the resident flora, invading upstream into the milk ducts. However, they are inhibited by the bacteriostatic factors in milk. When milk is stagnant, the inhibitory capacity decreases, making bacteria more likely to cause disease. The causes of milk stasis are therefore risk factors for mastitis.
1.2 Symptoms Initial symptoms are due to local stasis, localized in one area of ​​the mammary gland, accompanied by signs of inflammatory syndrome (swelling, heat, redness, pain) in the diseased breast.
If symptoms persist for more than 12-24 hours, a superinfection leading to infective mastitis may occur. Then the symptoms become more obvious: fever > 380C, reduced lactation, systemic symptoms such as (fatigue, myalgia, chills,...)
1.3 Treatment For mild mastitis (mastitis) No infection)
Symptomatic treatment: reduce swelling, pain with NSAIDs and cold compress Empty udder: Continue breastfeeding, express milk When mastitis persists for more than 12-24 hours with high fever : Use additional antibiotics against Staphylococcus aureus. If clinical improvement does not occur within 48-72 hours, ultrasound should be performed to detect breast abscess.
Consider antibiotics in mastitis: 10-14 duration of treatment may reduce the risk of recurrence. However, a shorter course (5-7 days) can be used in cases of rapid and complete response.

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