🔑 Key Learning

  • Breastfeeding difficulties can result from engorgement, mastitis, blocked ducts, or galactocele.
  • History and clinical exam help differentiate these causes.
  • Management includes continued breastfeeding, supportive care, and antibiotics if infection is present.

🔥 Mastitis

👀 Clinical Features

  • Localised, wedge-shaped area of swelling in one breast.
  • Tender, firm, warm, erythematous skin.
  • Systemic symptoms: fever, malaise.
  • May progress to abscess: fluctuant, tender lump.
Mastitis. Wedge-shaped erythema. Attribution: XXXANONXXX3245, CC BY-SA 4.0 , via Wikimedia Commons

💊 Management

  • Continue breastfeeding or expressing milk from the affected side.
  • Antibiotics: Oral flucloxacillin for 10–14 days if infection suspected.
  • If abscess suspected → refer for ultrasound and possible drainage.

💢 Engorgement

👀 Clinical Features

  • Bilateral breast swelling and tenderness, typically starting a few days post-delivery.
  • Skin may be tense, shiny, and warm.
  • Infant may struggle to latch due to breast fullness.

💊 Management

  • Encourage frequent breastfeeding or expressing.
  • Gentle breast massage and warm compresses before feeding.
  • Cold packs post-feed for pain relief.

🧱 Blocked Milk Ducts

👀 Clinical Features

  • Localised tender lump (pea-sized or larger).
  • Pain may improve after feeding or expression.
  • White "milk bleb" may be seen on nipple.

💊 Management

  • Continue breastfeeding to help relieve blockage.
  • Warm compress and massage toward nipple.

🥛 Galactocele

👀 Clinical Features

  • Benign milk-filled cyst.
  • Insidious onset, smooth, mobile, painless lump.
  • May express milky discharge on palpation.

💊 Management

  • Typically resolves with continued breastfeeding and expression.
  • If persistent or large, refer for ultrasound and aspiration if needed.

📝 Exam Clues & Clinchers

  • Mastitis: tender, erythematous wedge-shaped swelling + fever → flucloxacillin.
  • Engorgement: bilateral, shiny, tense breasts a few days postpartum → encourage feeding.
  • Blocked duct: tender local lump, improves post-feed → continue feeding + massage.
  • Galactocele: painless mobile lump, milky discharge → usually benign and self-limiting.