Breast Care, Breast Examination

and Breast Feeding

To:Jose Leonardo Ygnacio R.N.

By:Busa, Ana Marie V.

Mesurado, Christian

After 5 hours of classroom discussion and demonstration, the level II students will be able to:

I. Define the following terms:a. Breastb. Areolac. Lactationd. Colostrume. Latch – onf. Mammographyg. Mammary Gland

II. Explain the Anatomy and Physiology of BreastIII. Enumerate Problems Affecting BreastIV. Breast Care

a. Discuss the importance of Breast Careb. Explain the principles involvedc. Give guideline in doing Breast Care

c.1. For breastfeeding womenc.2. For non-breastfeeding women

V. Breast Examinationa. Discuss importance of Breast Examinationb. Explain the principles involvedc. Enumerate the indications of Breast Examination.d. Emphasize the general points to be considered in Breast Self

Examinatione. Describe the different positions in doing Breast Self Examinationf. Administer beginning skills in Breast Examination

VI. Breast Feedinga. Discuss the importance of Breast Feedingb. Explain the principles involvedc. List the indications and the contraindicationsd. State the advantages and the disadvantagese. Explains the 2 mechanisms involvedf. Give the Acronym of Breast Feedingg. Enumerate the types of nipplesh. Demonstrate beginning skills in Breastfeeding Position

VII. Burpinga. Discuss the importance of Burpingb. Explain the principles involvedc. Describe the different positions in Burpingd. Demonstrate beginning skills in Burping Positions

I. DEFINITION OF TERMS:

Breast – one of the two organs containing the mammary glands of the adult human female, located on the front of the chest. These glands are capable of secreting milk for the nourishment of the young.

Areola – a heavily pigmented area, tissue surrounding the nipple

Lactation – a period when the secreting portions of the gland produce milk after the birth of the young

Colostrum – yellowish or creamy appearing fluid that is thicker than milk and contains more protein, fat soluble vitamins and minerals

Mammary gland – are sweat or sebaceous gland modified through evolution

Mammography – is a breast imaging modality that does not require the infection on the contrast medium but can detect non palpable lesions

Latch-on – proper attachment of the infant to the breast for feeding

II. ANATOMY AND PHYSIOLOGY:

The breast or mammary glands are specialized sebaceous glands located in the superficial fascia between the second rib and sixth intercostals cartilage. The pectoral and anterior serratus muscles lie beneath each breast. Cooper’s ligaments support the breast, extending from the deep fascia to the skim covering each breast. The breasts are composed of adipose, fibrous, glandular tissues. Deep within the glandular tissue are the tree-like branching ALVEOLI (secretory units of the mammary gland in which milk production takes place) or acini, arranged in series of 15-42 lobes. The lobules are made up of many grapelike clusters of alveoli around small ducts. The ducts combine to form larger lactiferious ducts that open on the surface of the nipple.

At the center of each breast is the nipple, a conic elevation composed erectile tissue that becomes more rigid during sexual excitement, pregnancy and lactation.

One of the biologic functions of the breasts is to supply nourishment and protective anti-bodies to infants during the lactation process.

III. DIFFERENT PROBLEMS AFFECTING THE BREAST

Fibroadenomas – are most common benign lumps women between the ages 20-30yrs. These are fibrous modules which are usually firm and mobile often referred to as “breast mouse” because of its mobility.

Cysts – are fluid filled sacs found most commonly in women in the 40-60 age groups. They can vary in size and feel either soft or hard, in which case they may resemble carcinoma.

Breast Discomfort (mastalgia) – in which the breasts are generally lumpy, causes great anxiety to women

Duct Papillomas – are very common, caused by solitary benign lesions growing in one of the main ducts close to the nipple. Nipple discharge will be a sign.

Duct Ectasia – due to dilation of major or minor ducts within the breast leading to retention of secretions within them. Symptoms can be nipple discharge or retraction and/or a palpable mass.

Intertrigo – is a rash in the fold of the skin under (large) breasts, usually caused by not drying the area thoroughly or after excessive perspiration.

Hairs Around the areola - many women have some hairs around the nipple (on the areola). This is perfectly normal because there are hair follicles in the areola. If

the hairs are so many that they mimic the male hair pattern on chest or if they keep growing in larger and larger quantities that may mean that the body has higher levels of androgens (male hormones) than normal.

Breast Cancer Mass (Malignant Tumor) – very hard (like a bit of raw carrot) irregular shape, and feel bumpy (not smooth) mass. It may not be moveable during a breast self-exam, but since tissue around it may move, it’s sometimes hard to know if the lump is moving, or if healthy tissue around it is moving. Malignant breast tumors, if not detected and treated early, will continue to grow, invading and destroying adjacent normal tissue. They will spread to surrounding lymph nodes; then, by a process called metastasis, cancer cells will break away from the tumor and spread, through the lymph system and bloodstream, to other areas of the body.

Increase Venous Prominence – Lactating mothers will always have very visible veins on both breasts. A venous pattern that is on one breast only, however, may develop with certain types of breast tumors.

Peau d’ Orange (Edema of the Breast) – This is caused by lymphatic obstruction (lymph nodes have been removed or damaged and lymphatic fluid collects in those tissues, causing swelling or edema), which in turn causes a thickening of the skin. It typically originates in the surrounding skin and underneath the areola.

Retraction Signs – the inward displacement of the nipple below the level of surrounding breast tissue, may indicate an inflammatory breast lesion or cancer. It results from scar tissue formation within a lesion or large mammary duct. As the scar tissue shortens, it pulls adjacent tissue inward, causing nipple deviation, flattening and, finally, retraction.

Nipple Inversion – also sometimes called invaginated. The condition describes nipples which project into the breast mound rather than out of it. The condition can affect both nipples equally or might only occur on one side. The extent of inversion varies considerably, as does the effectiveness of methods used to draw out or protract the nipple.

Acute Mastitis – this is an inflammatory mass that causes the breast to be red, swollen, tender, hot and hard. Flu-like symptoms are associated with this condition.

Paget’s disease (Malignancy of the mammary gland) – This is an intraductal carcinoma, which initially appears as dry, scaly crusts and later spreads to the areola. The nipple may also become reddened, inflamed and irritated.

- A rare type of breast cancer which can occur in women and men. It shows up in and around the nipple, and usually signals the presence of breast cancer beneath the skin. Most cases are found in menopausal women, but can also appear in women that are as young as 20.

IV. BREAST CARE – A care rendered in preparation for breastfeeding.

A. Importance of Breast Care:- promote comfort- retains breast shape- prevents back strains- sensitivity of the breast in pregnancy is relieved- maintain proper hygiene

B. Principles involved in Breast Care:

Anatomy and Physiology - Involves the anatomy of the breast and uses parts of the body in performing breast care

Body Mechanics - Involves the proper position or posture in performing breast careMicrobiology- Cleaning the breast kills pathogenic microorganisms to prevent infections and to promote personal hygiene

Physics- Involves friction in cleaning the breast. Involves gravity to prevent the breast from sagging

Time and Energy- Preparation of necessary materials in performing breast care in order to conserve time and energy.

Epidemeology- Involves in knowing the factors determining and influencing the frequency and distribution of diseases, injury, and other health-related events.

Chemistry- Involves in proper handling and usage of chemicals to be used for cleansing.

Pharmacology- Involves in the medications and treatments in breast care.

Psychology-Increased awareness in breast care gives peace of mind.

C. Guidelines in doing Breast Care

C.1. for Breast Feeding Women

- Instruct mother to wash areola and nipples with water, without soap or a washcloth to avoid washing away natural oils and keratin.- Advise the mother with sore or irritated nipples to apply ice compress just before breast feeding. This numbs and firms the nipple making them less sensitive and easier for the infant to grasp.- Suggest that lubricating the nipple with a few drops of expressed breast milk before feeding may help prevent tenderness.- Recommend placing breast pads over the nipples to collect colostrum or milk which commonly leaks during the first few breast feeding weeks. Advise replacing pads often to guard against infections.- Inform the mother that breast milk comes in 2 – 5 days after delivery and is accompanied by a slight temperature elevation and breast changes – increase in size, warmth and firmness.- Tell mother that a well fitting support bra may help control engorgement.- Advise mother with engorged breast to apply warm compress, massage the breast, take a warm shower or express some milk before feeding. This dilates the milk ducts, promotes let down and makes the nipples more pliable.

C.2. for non-Breast Feeding Women

- Instruct the mother to clean her breast using the same technique as the breast feeding mother. Add that she may use soap however.- Advise her to wear support bra to help minimize engorgement and to decrease nipple stimulation.- Advise her to avoid stimulating the nipples or manually expressing her milk to minimize further milk production. Instead provide medication as ordered, ice packs or a breast binder.

How to do Breast Self Examination

Stand before a mirror. Inspect both breasts foranything unusual such as any discharge from the

nipples or puckering, dimpling, or scaling of theskin.

Watching closely in the mirror, clasp your hands behind your head and press your hands forward.

Next, press your hands firmly on your hips and bow slightly towards your mirror as you pull your shoulders and elbows forward.

Raise your left arm. Use three or four fingers of your right hand toexplore your left breast firmly, carefully, and thoroughly. Beginning atthe outer edge, press the flat part of your fingers in small circles, movingthe circles slowly around the breast. Gradually work toward the nipple.

Be sure to cover the entire breast. Pay special attention to the area between the breast and the underarm, including the underarm itself. Feel for any unusual lump or mass under the skin.

Gently squeeze the nipple and look for a discharge. (If you have any discharge during the month - whether or not it is during BSE - see your doctor.) Repeat steps 4 and 5 on your right breast.

Steps 4 and 5 should be repeated lying down. Lie flat on your back with

your left arm over your head and a pillow or folded towel under your leftshoulder. This position flattens the breast and makes it easier to examine.Use the same circular motion described earlier. Repeat the exam on your right breast.

V. BREAST EXAMINATION: – A manual examination conducted monthly by a woman to evaluate her own breast for signs of masses, changes, nipples discharge or evidence of abnormalities.

A. Importance of Breast Examination:- to examine any changes in color, size, shape of the breast, puckering or

dimpling of the skin or changes in nipples- to early detect any deformities or abnormalities of the breast- checking the conditions of your breast- To become familiar with your breast – familiarity of your breast makes it

easier to notice changes.

B. Principles involved in Breast Examination:

Anatomy and Physiology – Involves the anatomy of the breast and uses parts of the body in performing breast exam.

Body Mechanics - Involves the proper position or posture in performing breast exam

Microbiology - Cleaning the breast kills pathogenic microorganisms to prevent infections and to promote personal hygiene

Physics - Involves friction in performing the breast exam and palpating the breast, involves gravity to prevent the breast from sagging

Time and Energy - Preparation of necessary materials in performing breast exam in order to conserve time and energy.

Psychology- For better awareness on breast illnesses.

C. Indications of Breast Examination:- Menstruating women- Women who are no longer menstruating- Women using oral contraceptives- Women older than 20 years should perform monthly breast self-

examinations.

D. General points emphasized in Breast Self Examination:

1. Examine breast once a month just after the menstrual period, because breast are less engorged and a tumor is easier to detect and at regular monthly interval after the cessation of menses.

2. Compare findings with the opposite breast.3. Remind patients that 90% breast lumps are not cancerous.4. Do not neglect men when teaching BSE- 1% of breast cancer occurs in

men.

E. Different positions in doing Breast Self Examination

The side lying position: lie on the opposite side of the breast to be examined.Rotate the shoulder on the same side of the breast to be examined back to the flat surface. The side lying position enables large breasted women to most effectively examine the outer portion of the breast.

For the flat position, lie flat on your back with a pillow or folded towel under the shoulder of the breast to be examined.

In front of the mirror standing position or in the shower.

Pattern of Search

Vertical Strip:Start in the armpit, proceed downward to the lower boundary. Move a finger's width toward the middle and continue toward the middle and continue palpating upward until you reach the collarbone. Repeat this until you have covered all the breast tissue. Make at least 6 strips before the nipple and four strips after the nipple. You may need between 10 and 16 strips.

Wedge:Imagine your breast divided like the spokes of a wheel with the nipple in the center. Examine each segment, moving from the outside boundary toward the nipple. Slide fingers back to the boundary, move over a finger's width and repeat this procedure until you have covered all breast tissue. You may need between 10 and 16 segments.

Circle:

Imagine your breast as the face of a clock. Start at 12 o'clock and palpate along the boundary of each circle until you return to your starting point. The move down a finger's width and continue palpating in ever smaller circle until you reach the nipple. Depending on the size of your breast, you may need 8 to 10 circles.

VI. Breast Feeding- is a learned behavior that all mothers decide to do the extent of understanding conveyed about lactation and nourishment of an infant.

A. Importance of Breast Feeding:

- provide newborn and infants with specific immunologic, nutritional, psycho-social advantages.- Breastfeeding is free, readily available and enhances the relationship between mother and baby.- Breast milk is the healthiest food for babies and offers the most complete nutrition, such as antibodies to help fight illness.- Breast milk changes to meet the baby’s nutritional needs as he or she grows.

B. Principles involved in Breast Feeding:

Anatomy & Physiology-involves the anatomy of the breast feeding the baby.

Body Mechanics-involves proper positioning in feeding the baby.

Microbiology- involves the cleaning of the breast before you let the baby suck the breast of the mother to avoid infections.

Physics- involves friction due to the sucking of the baby of the breast

Time and Energy- it saves time and conserves energy rather than bottle feeding.

C. Indications and Contraindications of Breast Feeding

Indications:

-newly born babies-need for nutrition-when mother is lactating

Contraindications:-a mother w/ a diagnosis of breast cancer-women w/ HIV/AIDS-maternal medications-heavy sedations of the mother-physical compromise of either mother or baby-Hepatitis B virus-Herpes lesions on the mother’s nipples

D. Advantages and Disadvantages of Breastfeeding

Advantages for Infants:-provides a favorable balance of nutrients with high bioavailability-provides hormones that promote physiological development-improves cognitive development-may protect against some chronic disease such as diabetes and hypertension later in life-protects against food allergies- decreased incidences of ear infections, diarrhea, and some respiratory problems in breastfed babies.- breast-fed infants gain less weight and tend to be leaner at 1 year of age than formula-fed infants. This early indicator may influence later growth patterns, resulting in fewer overweight and obese children.

Advantages for Mothers:- Breast-feeding releases a hormone in a woman's body that causes her uterus to return to its normal size and shape more quickly and reduces blood loss after delivery.-delays the return of the regular ovulation thus lengthening birth intervals-conserves iron stores by prolonging amenorrhea- breast-feeding for longer periods of time (up to 2 years) and among younger mothers may reduce the risk of premenopausal and possibly postmenopausal breast cancer.- Most women who persevere with breast-feeding have a great sense of accomplishment and recognize the importance of providing their child with the best possible nutrition.- mothers who breastfeed their babies have fewer episodes of post-delivery depression.

Disadvantages of Breast Feeding:-breast discomfort-sore or leaking nipples

-increased incidents of mastitis-engorgement-less personal time than in bottle-feeding-vaginal dryness *medications such as metronidazole use to treat trichomoniasis pass into the breast milk and maybe harmful to the breast-feeding infant-Exclusion of father from the nurturing involved in feeding the infant.

E. Mechanisms:Sucking- stimulates the release of oxytocin

Oxytocin - is a hormone produced by the posterior pituitary that stimulates uterine contractions and release of milk from the mammary glands. It increases the contractility of the myoepithelial cells that lines the wall of the mammary ducts resulting in the let-own reflex.

Let-Down Reflex- is the ejection of milk from the breast and milk flow toward the nipple triggered by nipple stimulation or emotional response for the infant

F. Acronym of Breast Feeding

B- Best for baby

R- Reduces incidence of allergies

E- Economical

A- Antibodies-provides immunity to some disease

S- Stool is inoffensive and hardly constipated

T- Temperature is always ideal

F- Fresh- never goes sour

E- Emotionally bonding

E- Easy once established

D- Digested easily

I- Immediately available

N- Nutritionally optimal (best)

G- Gastroenteritis greatly reduce

G. Types of Nipples

H. Breast Feeding Position

A. Football Hold-hold the baby’s back and shoulders in the palm of your hand-Tuck the baby up under your arm, lining up the baby’s lips with your nipple-support the breast to guide it into the baby’s mouth-hold your breast until the baby’s nurses easily

B. Side Lying Position

-Lie on your side with a pillow at your back and lay the baby under the breast facing each other.-to start, prop yourself up on your elbow and support your breast with the opposite hand-pull the baby close to you turning up the baby’s mouth with your nipples

C. Cradling Position-cradle the baby in the arms closest to the breast, with the baby’s head in the crook of the arm.-have the baby’s body facing you, tummy to tummy-use your opposite arm to support the breast.

D. Across the Lap Position-Lay your baby on pillows across the lap.-Turn the baby facing you

-Reach across your lap to support the baby’s back and shoulders with the palm of your hand.

-Support your breast from underneath to guide it into the baby’s mouth.

VII. BURPING- To pat a baby on the back to cause it to belch.

Belch - to expel gas from the stomach by the mouth.

A. Importance of Burping:

-to release ingested air-can increase the consumption of food

B. Principles involved in Burping:

Anatomy and Physiology- involves the anatomy of the baby and uses part of the body in positioning the baby in burping.

Body Mechanics- involves the proper positioning of the baby.

Physics- involves force on patting the baby to burp.

C. Different Positions in Burping

1. Supported on the shoulder 2.Upright on the lap 3. Face down across the lap

Supplementary Pictures