Change process of nipple tissue after initiating breastfeeding

Abstract

Purpose

The aim of this study was to clarify the change process of nipple tissue after initiating breastfeeding.

Methods

Fifty Japanese breastfeeding women were enrolled at an obstetrics and gynecology clinic in Sapporo, Japan, from October 2016 to January 2017. Collected photographs were processed for color correction using CASMATCH^® (KENIS Ltd., Osaka, Japan) and size correction using image-editing software (Photoshop 6, Adobe System Inc., Tokyo, Japan) and were displayed in chronological order. Visual analysis was conducted by three researchers based on the following seven nipple skin changes defined in a previous study: “erythema”, “swelling”, “blistering”, “scabbing”, “fissure”, “purpura”, and “peeling”. In addition, these data were analyzed together with nipple pain and characteristics of participants. Observed results are organized based on three factors: the order of signs, chronological changes in one sign, and the relationship among the sings. A model was developed to describe the change process of nipple tissue.

Results

A total of 776 images were collected, and the following 15 patterns pertaining to the change process of nipple tissue were revealed. There were seven patterns pertaining to the order of signs: 1) development of “erythema” and/or “swelling” → improvement or healing; 2) “erythema” and/or “swelling” → “fissure” → epithelialization → healing; 3) “fissure” → healing; 4) “erythema” and/or “swelling” → “blistering” → rupture → “scabbing”; 5) “blistering” → rupture → “scabbing”; 6) “erythema” → “scabbing”; and 7) “erythema” and/or “swelling” → “scabbing” → “erythema” of the peeled area. There were four patterns of chronological changes in one sign: 1) course of “fissure”, 2) course of “blistering”, 3) developing patterns of bloody “scabbing”, and 4) signs that predicted peeling of “scabbing”. There were four patterns of relationships among the sings: 1) relationship between “erythema” and/or “swelling” and development of “blistering” or “scabbing”, 2) relationship between “swelling” and “blistering”, 3) relationship between “swelling” and “peeling” or worsening of “scabbing”, and 4) relationship between “purpura” and/or “peeling” and the others.

Conclusion

The change process of nipple tissue after initiating breastfeeding was presented based on daily nipple images. The findings of this study suggest that observations focusing on minor changes in the nipple tissue, such as “erythema” and/or “swelling” prevents more severe nipple trauma that can lead to the discontinuation of breastfeeding.