ASSESSMENT OF BREASTS AND NIPPLES

Kittie Frantz, RN, CPNP-PCClinical Instructor in Pediatrics

Keck School of Medicine atThe University of Southern California

frantz@usc.edu

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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, LLC3

Size is dictated by fat

© 1999 K Hoover

© 1999 K Hoover 4

GLANDULAR STRUCTURE

© Ruth Lawrence

© 2006 Medela, Ag

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Lack of glandular tissue

© 1982 Kittie Frantz 6

Lack of glandular tissue

©1982 Kittie Frantz

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Lack of glandular tissue

© 1982 Kittie Frantz8

Lack of glandular tissue often looks tubular

www.007b.com9

Lack of glandular tissue can look unusual

www.007b.com10

Lack of glandular tissue can be all but under the areola

©1985 Kittie Frantz 11

Normal for hair on the areola

© 1999 K Hoover

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Normal to see a size difference

©1980 Kittie Frantz 13

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 BreastPolymastia

© 1999 K Hooverr 16

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 18

Breast surgery - reduction

• www.bfar.org

© K Frantz19

Breast surgery – augmentation behind the breast

©1982 Kittie Frantz

From A Collection of Breasts, Geddes Productions, LLC

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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 Lawrence24

Flat nipple is a hypotonic nipple

©1982 Kittie Frantz

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Flat nipple temporarily caused by C/S muscle relaxant medications

© Kittie Frantz26

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, LLC31

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 Bergman36

Nipple shield mayprovide the nipple

baby seeks

Medela Ag

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Feeding tube device adds milk to sustain his suckling

Medela Ag38

…Or you may have to use both

© 1999 K Hoover© 1999 K Hoover

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Supernumerary nipples

© 1999 K Hoover

© 1982 Kittie Frantz

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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 Frantz44

Long nipple common in

Asian women

© 1979 Barbara Kalmen

Gift from patient

Gift from patient45

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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