Transcript APPEARANCE OF MOTHER`S BREAST AND NIPPLES

ASSESSMENT OF BREASTS
AND NIPPLES
Kittie Frantz, RN, CPNP-PC
Clinical Instructor in Pediatrics
Keck School of Medicine at
The University of Southern California
[email protected]
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PHYSICAL ASSESSMENT
• The adolescent exam is the best time to assess
breasts and nipples
• The prenatal exam is the next opportunity
• The mother of the breastfeeding infant
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BREASTS
From “A Collection of Breasts”, Geddes Productions, LLC
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Size is dictated by fat
© 1999 K Hoover
© 1999 K Hoover
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GLANDULAR STRUCTURE
© Ruth Lawrence
© 2006 Medela, Ag
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Lack of glandular tissue
© 1982 Kittie Frantz
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Lack of glandular tissue
©1982 Kittie Frantz
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Lack of glandular tissue
© 1982 Kittie Frantz
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Lack of glandular tissue often looks
tubular
www.007b.com
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Lack of glandular tissue can look unusual
www.007b.com
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Lack of glandular tissue can be all but under the
areola
©1985 Kittie Frantz
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Normal for hair on the areola
© 1999 K Hoover
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Normal to see a size difference
©1980 Kittie Frantz
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So..How many babies can she breastfeed?
© 1990 N Wohlfarth
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Triplets and quads have breastfed well
© 1990 Kittie Frantz
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Extra Breast
Polymastia
© 1999 K Hoover
r
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Extra breast often in axilla
© 1999 K Hoover
© 1999 K Hoover
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Extra breast without nipple is a
hyperadenia
© 1986 Kittie Frantz
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Breast surgery - reduction
• www.bfar.org
© K Frantz
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Breast surgery – augmentation behind
the breast
From A Collection of Breasts, Geddes Productions, LLC
©1982 Kittie Frantz
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Breast surgery – augmentation via areola
© 1999 K Hoover
© 1982 Kittie Frantz
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NIPPLES
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Large and small
© 1999 K Hoover
© 1999 K Hoover
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Erects due to muscle rings
© R Lawrence
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Flat nipple is a hypotonic nipple
©1982 Kittie Frantz
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Flat nipple temporarily caused by
C/S muscle relaxant medications
© Kittie Frantz
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Atonic nipple – no muscle rings
© 2005 Kittie Frantz
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Inverted nipple – adhesions pull
nipple inward
© 1999 K Hoover
© 1999 K Hoover
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Severe adhesions – buried nipple
© 1979 Kittie Frantz
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WHAT TREATMENT TO USE?
That depends on the diagnosis
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Hoffman’s technique &
breast cups/shells used prenatally for
inverted nipples
© 1995 Kittie Frantz
From A Collection of Breasts, Geddes Productions, LLC
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The Nipplett correction use pre
conception for inverted nipple
Avent Product photo
Avent Product photo
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The Nipplette result
• www.aventamerica.com
Avent Product photo
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So, how does baby do this again?
© 2002 Kittie Frantz
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Remember he is equipped to reach
& gather the areola with his tongue
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Self attachment may surprise you!
© N Bergman
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Nipple shield may
provide the nipple
baby seeks
Medela Ag
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Feeding tube device adds milk to
sustain his suckling
Medela
38 Ag
…Or you may have to use both
© 1999 K Hoover
© 1999 K Hoover
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Supernumerary nipples
© 1982 Kittie Frantz
© 1999 K40
Hoover
Supernumerary nipple
© 1999 K Hoover
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Supernumerary nipple
www.007b.com
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Bifid nipple
© 1980 Kittie Frantz
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Redundant nipple
© 1982 Kittie Frantz
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Long nipple
common in
Asian women
Gift from patient
© 1979 Barbara Kalmen
Gift from patient
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Laid-back positioning uses gravity to
get baby past the nipple and
onto the areola
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Helping her to feel good about herself
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Family practice & OB/GYN doctors
need to address this prenatally
© H Quimby
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…And when we work around it,
breastfeeding can be successful
© 1980 Kittie Frantz
©Kittie Frantz
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Questions?
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