Jan and Cherie
Case presented as:
breast reduction surgery 3 years ago that caused much scar tissue
One-week-old baby seems to be getting enough milk /mom is producing plenty
of milk
mom is in GREAT pain / felt during feeding and in the scar tissue area
The mom had a large areola before the surgery and now it is quite smaller
her nipple is very large / baby has a little difficulty, but manages to take
in enough breast for an effective latch

Cherie asked: "Is it possible that the breast reduction in the areolar
region caused any
lactiferous sinus to be in a non-areolar region now?"   Yes, I think it is
possible
"I am wondering if this is something specific to the surgery itself and
independent to typical
engorgement/plugged duct/etc."  I would think a combination of things is
going on.

I had a mom with a very successful experience who breastfed exclusively for
6 months despite free nipple grafting type of breast reduction 10 years
earlier.  I posted about her several times earlier under my old address of
[log in to unmask]  She did have trouble with pain. If the baby latched
directly over the old suture line she felt distinct pain, which I attributed
to compression of scar tissue.  If the baby latched too shallowly she had
the typical nipple pain.  We were able to find a compromise between too deep
and too shallow that worked to give adequate milk while not making nipple or
suture line pain unbearable for her.

In the case of Cherie's client it sounds like the reduction in the size of
the areola placed the suture lines quite close to the large nipple.  Is it
possible to latch the baby outside the suture line?  Have you tried
different positions and varying the degree of asymmetry in the latch?  There
may be areas that are tenderer than others.  If the pain is going to cause
weaning and nothing else works perhaps a pump and try again after waiting
for growth or just some healing time.

Carla
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