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 (breastmilk-
milled 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
Supportive 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.