ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz RN

ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California frantz@usc. edu 1

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 2

BREASTS From “A Collection of Breasts”, Geddes Productions, LLC 3

Size is dictated by fat © 1999 K Hoover 4

GLANDULAR STRUCTURE © Ruth Lawrence © 2006 Medela, Ag 5

Lack of glandular tissue © 1982 Kittie Frantz 6

Lack of glandular tissue © 1982 Kittie Frantz 7

Lack of glandular tissue © 1982 Kittie Frantz 8

Lack of glandular tissue often looks tubular www. 007 b. com 9

Lack of glandular tissue can look unusual www. 007 b. com 10

Lack of glandular tissue can be all but under the areola © 1985 Kittie Frantz 11

Normal for hair on the areola © 1999 K Hoover 12

Normal to see a size difference © 1980 Kittie Frantz 13

So. . How many babies can she breastfeed? © 1990 N Wohlfarth 14

Triplets and quads have breastfed well © 1990 Kittie Frantz 15

Extra Breast Polymastia © 1999 K Hoover r 16

Extra breast often in axilla © 1999 K Hoover 17

Extra breast without nipple is a hyperadenia © 1986 Kittie Frantz 18

Breast surgery - reduction • www. bfar. org © K Frantz 19

Breast surgery – augmentation behind the breast From A Collection of Breasts, Geddes Productions, © 1982 Kittie Frantz 20

Breast surgery – augmentation via areola © 1999 K Hoover © 1982 Kittie Frantz 21

NIPPLES 22

Large and small © 1999 K Hoover 23

Erects due to muscle rings © R Lawrence 24

Flat nipple is a hypotonic nipple © 1982 Kittie Frantz 25

Flat nipple temporarily caused by C/S muscle relaxant medications © Kittie Frantz 26

Atonic nipple – no muscle rings © 2005 Kittie Frantz 27

Inverted nipple – adhesions pull nipple inward © 1999 K Hoover 28

Severe adhesions – buried nipple © 1979 Kittie Frantz 29

WHAT TREATMENT TO USE? That depends on the diagnosis 30

Hoffman’s technique & breast cups/shells used prenatally for inverted nipples © 1995 Kittie Frantz From A Collection of Breasts, Geddes Productions, LLC 31

The Nipplett correction use pre conception for inverted nipple Avent Product photo 32

The Nipplette result • www. aventamerica. com Avent Product photo 33

So, how does baby do this again? © 2002 Kittie Frantz 34

Remember he is equipped to reach & gather the areola with his tongue 35

Self attachment may surprise you! © N Bergman 36

Nipple shield may provide the nipple baby seeks Medela Ag 37

Feeding tube device adds milk to sustain his suckling Medela Ag 38

…Or you may have to use both © 1999 K Hoover 39

Supernumerary nipples © 1982 Kittie Frantz © 199940 K Hoover

Supernumerary nipple © 1999 K Hoover 41

Supernumerary nipple www. 007 b. com 42

Bifid nipple © 1980 Kittie Frantz 43

Redundant nipple © 1982 Kittie Frantz 44

Long nipple common in Asian women Gift from patient © 1979 Barbara Kalmen Gift from patient 45

Laid-back positioning uses gravity to get baby past the nipple and onto the areola 46

Helping her to feel good about herself 47

Family practice & OB/GYN doctors need to address this prenatally © H Quimby 48

…And when we work around it, breastfeeding can be successful © 1980 Kittie Frantz ©Kittie Frantz 49

Questions? 50