Now, let's discuss breastfeeding.
So there are several benefits to breastfeeding.
Both maternal and fetal.
For that reason we do encourage breastfeeding
in most situations.
There are some indications such as moms are infected with HIV
and Hepatitis C.
Where breastfeeding is contraindicated.
However, in most situation it is definitely encouraged.
So let's go through some of those maternal benefits.
Weight loss after pregnancy.
Decreased unintended pregnancy.
As it can sometimes inhibit ovulation.
Decreased rates of hypertension and cardiovascular disease
in the mom over her lifetime.
There's also a decreased rate of breast and ovarian cancer
over her lifetime.
This is thought to be because during the time of breastfeeding
estrogen levels are lower.
And without having an ovulation that thought to be protected
against ovarian cancer.
And then the lower rates of postpartum depression.
And this is thought that because of breastfeeding
there's an increased bonding between mom and the baby.
So fetal benefits.
Decreased childhood common illnesses.
So through the IgA antibodies when baby breast feeds,
he's able to get some antibodies from mom to protect him
from different illnesses.
Decreased rates of obesity in babies that were breast fed.
And again there's increased bonding
between mother and infant.
So that not only helps mom to decrease the risk of postpartum
depression but it also helps infant.
And although this is not a completely proven,
we think that babies that are breast fed are also
cognitively perform better in school.
So let's take a case.
A 27 year old Para 1 female that delivered
a healthy female by vaginal delivery 2 weeks earlier,
presents to your office with complaint
of bilateral breast pain.
She reports the baby has had difficult latch so she is mostly
pumping to produce breast milk.
She reports a low grade fever.
On physical exam both breast are firm and tender
with no erythema.
What diagnosis best describes this patient's condition?
A. Mastitis.
B. Engorgement.
C. Galactocele.
or D. Breast abscess.
Well let's talk about some issues that we can have
with breastfeeding and see if we can find the answer.
So there four common breast conditions that we see
with breastfeeding.
Engorgement, Mastitis, Galactocele and Breast abscess.
With Engorgement, the breast are full of milk
and they're just not completely emptying.
This can be bilateral.
Patients can have a low grade fever.
It's common when there is problem with the latch.
And treatment is just to increase breastfeeding,
warm compression and massage.
You are just trying to get those milk ducts to empty.
Next is mastitis.
Now this is actually an infectious process.
Mastitis is usually unilateral.
The breast is usually warm.
There is erythematous streaking.
The most common culprit is Staphylococcus aureus
and the treatment is antibiotic.
Dicloxacillin as well as continue breastfeeding.
The next is Galactocele.
So this is a cyst that can form in the breast
because of a blocked milk duct.
So with the galactocele,
there's usually a palpable tender, firm mass.
There's no fever because remember it's not infectious.
Usually unilateral.
And the treatment is the same as Engorgement.
Increased breastfeeding, warm compresses and massage.
Again you're just trying to get that milk duct to empty.
And then finally we can have breast abscess which is actually
an infectious process.
This is usually unilateral.
There's fluctuant mass.
Patients can have fever, malaise.
And the treatment for this abscess is the same
as any abscess.
It's incision and drainage followed by antibiotics.
So let's go back to our patient.
Again she's a 27 year old para 1 female that delivered
a healthy female by vaginal delivery 2 weeks earlier.
She's coming to your office with complaint of breast pain.
She reports the baby had difficult latching.
And she is mostly pumping to produce breast milk.
She reports a low grade fever.
On physical exam both breasts are firm and tender
with no erythema.
So what do you think is going on with this patient?
Is it A. Mastitis.
B. Engorgement.
C. Galactocele.
or the D. Breast abscess.
That's right the answer is Engorgement.
Remember with Engorgement, is bilateral,
such as with our patient.
They have low grade fever.
That will take out the option of Mastitis
as that's usually unilateral.
Galactocele remember has no fever.
And with Breast abscess, that's also unilateral
and there's a fluctuant mass on physical exam.