ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck...

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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] 1

Transcript of ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck...

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

ASSESSMENT OF BREASTS AND NIPPLES

Kittie Frantz, RN, CPNP-PCClinical Instructor in Pediatrics

Keck School of Medicine atThe University of Southern California

[email protected]

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Page 2: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

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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Page 3: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

BREASTS

From “A Collection of Breasts”, Geddes Productions, LLC3

Page 4: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Size is dictated by fat

© 1999 K Hoover

© 1999 K Hoover 4

Page 5: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

GLANDULAR STRUCTURE

© Ruth Lawrence

© 2006 Medela, Ag

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Page 6: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Lack of glandular tissue

© 1982 Kittie Frantz 6

Page 7: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Lack of glandular tissue

©1982 Kittie Frantz

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Page 8: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Lack of glandular tissue

© 1982 Kittie Frantz8

Page 9: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Lack of glandular tissue often looks tubular

www.007b.com9

Page 10: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Lack of glandular tissue can look unusual

www.007b.com10

Page 11: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Lack of glandular tissue can be all but under the areola

©1985 Kittie Frantz 11

Page 12: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Normal for hair on the areola

© 1999 K Hoover

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Page 13: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Normal to see a size difference

©1980 Kittie Frantz 13

Page 14: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

So..How many babies can she breastfeed?

© 1990 N Wohlfarth

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Page 15: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Triplets and quads have breastfed well

© 1990 Kittie Frantz

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Page 16: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Extra BreastPolymastia

© 1999 K Hooverr 16

Page 17: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Extra breast often in axilla

© 1999 K Hoover

© 1999 K Hoover

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Page 18: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Extra breast without nipple is a hyperadenia

© 1986 Kittie Frantz 18

Page 19: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Breast surgery - reduction

• www.bfar.org

© K Frantz19

Page 20: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Breast surgery – augmentation behind the breast

©1982 Kittie Frantz

From A Collection of Breasts, Geddes Productions, LLC

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Page 21: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Breast surgery – augmentation via areola

© 1999 K Hoover

© 1982 Kittie Frantz

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Page 22: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

NIPPLES

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Page 23: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Large and small

© 1999 K Hoover © 1999 K Hoover

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Page 24: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Erects due to muscle rings

© R Lawrence24

Page 25: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Flat nipple is a hypotonic nipple

©1982 Kittie Frantz

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Page 26: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Flat nipple temporarily caused by C/S muscle relaxant medications

© Kittie Frantz26

Page 27: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Atonic nipple – no muscle rings

© 2005 Kittie Frantz

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Page 28: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Inverted nipple – adhesions pull nipple inward

© 1999 K Hoover© 1999 K Hoover

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Page 29: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Severe adhesions – buried nipple

© 1979 Kittie Frantz

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Page 30: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

WHAT TREATMENT TO USE?

That depends on the diagnosis

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Page 31: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Hoffman’s technique &breast cups/shells used prenatally

for inverted nipples

© 1995 Kittie Frantz

From A Collection of Breasts, Geddes Productions, LLC31

Page 32: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

The Nipplett correction use pre conception for inverted nipple

Avent Product photo Avent Product photo

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Page 33: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

The Nipplette result

• www.aventamerica.com

Avent Product photo

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Page 34: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

So, how does baby do this again?

© 2002 Kittie Frantz

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Page 35: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

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

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Page 36: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Self attachment may surprise you!

© N Bergman36

Page 37: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Nipple shield mayprovide the nipple

baby seeks

Medela Ag

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Page 38: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Feeding tube device adds milk to sustain his suckling

Medela Ag38

Page 39: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

…Or you may have to use both

© 1999 K Hoover© 1999 K Hoover

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Page 40: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Supernumerary nipples

© 1999 K Hoover

© 1982 Kittie Frantz

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Page 41: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Supernumerary nipple

© 1999 K Hoover

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Page 42: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Supernumerary nipple

www.007b.com

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Page 43: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Bifid nipple

© 1980 Kittie Frantz

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Page 44: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Redundant nipple

© 1982 Kittie Frantz44

Page 45: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Long nipple common in

Asian women

© 1979 Barbara Kalmen

Gift from patient

Gift from patient45

Page 46: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

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

onto the areola

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Page 47: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Helping her to feel good about herself

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Page 48: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Family practice & OB/GYN doctors need to address this prenatally

© H Quimby

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Page 49: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

…And when we work around it, breastfeeding can be successful

© 1980 Kittie Frantz©Kittie Frantz

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Page 50: ASSESSMENT OF BREASTS AND NIPPLES Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California.

Questions?

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