Joanna wrote:

<Had never run into this before but in the last month I have worked with two
moms who had brst infection drained in first 1-2 weeks of life.  In each
case the damaged breast looked normal but minimal milk production despite
exactly same stim as the undamaged breast (which produced normally).  In
each case the incision was roughly in the 3-6 oclock zone (hard to detect
the scar tissue).  Nerve damage?

In thinking further about the previous such case and Joanna's cases and
observations and question, it seems to me that the direction of the wound
for the placement of the drain, if made radially, that is, in  the same
direction as the ducts, might be less likely to interrupt as many ducts,
since it might accidentally fall in the connective tissue space between
ducts,  or perhaps make a longitudinal insidion of any duct(s). If the slash
were made diagonally on the areola, at a right or any degree of angle to the
direction of the ducts, it would seem more likely to completely sever the
ducts.

I have had several types of surgery after which I noticed interrupted the
skin nerves sensation (skin cysts, old fashioned gall bladder surgery, etc.)
and while the area beyond the incision was numb for quite a few months, the
sensation eventually returned. So my personal guess is that nerve
regeneration might be more likely than regeneration of severed ducts and
effective recanalization through the scar tissue, particularly at such a
crucial early developmental stage . Even if nerves remained severed, the
stimulation of the undamaged side would be enough to trigger MER in both
sides.

Sounds as if this scenario might be more common than we realize.  Joanna and
Christine, could you possibly talk to the mothers and arrange to use a
magnifying glass and get a more specific history from them or their families
to determine the direction of the scars in relation to the general direction
of ducts? Perhaps the two of you could collaborate to write up a set of case
studies?


If anyone else comes across such cases, it would be good to have case
studies and close-up photographs, paying particular attention to the
direction of the scar, Perhaps our professional observations might persuade
today's surgeons treating such cases to consider a radial direction for the
incision for a drain for female babies, so as to lower the risks of problems
in future lactations.of that baby girl.

Jean
**************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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