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. Breast
b. Areola
c. Lactation
d. Colostrum
e. Latch – on
f. Mammography
g. Mammary Gland

II. Explain the Anatomy and Physiology of Breast

III. Enumerate Problems Affecting Breast
IV. Breast Care
a. Discuss the importance of Breast Care
b. Explain the principles involved
c. Give guideline in doing Breast Care
c.1. For breastfeeding women
c.2. For non-breastfeeding women
V. Breast Examination
a. Discuss importance of Breast Examination
b. Explain the principles involved
c. Enumerate the indications of Breast Examination.
d. Emphasize the general points to be considered in Breast Self
Examination
e. Describe the different positions in doing Breast Self Examination
f. Administer beginning skills in Breast Examination
VI. Breast Feeding
a. Discuss the importance of Breast Feeding
b. Explain the principles involved
c. List the indications and the contraindications
d. State the advantages and the disadvantages
e. Explains the 2 mechanisms involved
f. Give the Acronym of Breast Feeding
g. Enumerate the types of nipples
h. Demonstrate beginning skills in Breastfeeding Position
VII. Burping
a. Discuss the importance of Burping
b. Explain the principles involved
c. Describe the different positions in Burping
d. 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 care
Microbiology
- 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 for

anything unusual such as any discharge from the
nipples or puckering, dimpling, or scaling of the
skin.

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 to
explore your left breast firmly, carefully, and
thoroughly. Beginning at
the outer edge, press the flat part of your fingers in
small circles, moving
the 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 left
shoulder. 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