[Breastfeeding (part III): Breastfeeding complications--Guidelines for clinical practice].

OBJECTIVE

Provide guidelines for management of breastfeeding complications.

METHODS

Systematically review of the literature between 1972 and May 2015 from the database Medline, Google Scholar, Cochrane Library, and the international recommendations about inhibition of lactation with establishment of levels of evidence (EL) and grades of recommendation.

RESULTS

Nipple stimulation preparation techniques or antenatal correction an anatomical variation of the nipple are not recommended to decrease nipple complications or improve the success of breastfeeding (grade B). The use of lanolin and application of breast milk may have an interest in diseases of the nipple (EL4). The current published data are insufficient to conclude on the effectiveness of nipple shield, (professional consensus). Manual breast expression or using a breast pump may have an interest in preventing breast engorgement (professional agreement). A bacteriological sample of milk for mastitis is necessary to decide an antibiotic and interrupt breastfeeding with breast infected while continuing its drainage with a breast pump (professional consensus). Incision and drainage of breast abscess are recommended (professional consensus) and iterative puncture is an alternative to surgical drainage in the moderate forms (professional consensus). Breastfeeding is not contraindicated for women with a past history of esthetic breast surgery or breast cancer (professional consensus). There is no scientific justification to recommend the use of breast pumps to improve breastfeeding (grade B). Because of the potential side effects, the use of domperidone and metoclopramide are not recommended in the stimulation of lactation (grade C).

CONCLUSIONS

Breastfeeding exposes women to specific complications, which may impede the continuation of breastfeeding. Prevention of mastitis is essential.