Amy writes:

<During our follow up on 5/29/12 she reported that baby was taking the breast well for every feeding (yay!!) and her nipples had healed but she *was* experiencing a painful pulling or dragging sensation on her areola. She also experienced this while gently washing  her breasts in the shower. Mom has implants and incisions around areola. Any one have any experience with this? 
She asked if there was anything she can do to numb her areola before feeding. I discouraged her from using any numbing agents as they would get in baby's mouth. Other than ice, any suggestions? >


I once read in a radiology reference that when doing ductal imaging that requires injection of dye through use of a  tiny catheter introduced though a nipple opening, radiologists may sometimes need to "raise the pain threshold" for women. They do this by using a folded washcloth saturated with the warmest water a woman can tolerate comfortably on her inner wrist, applying the warm, wet pack to both the nipple and areola and allowing it to cool to body temperature before proceeding. I have often used this method to raise the pain threshold when necessary in a new mother. To keep warm water nearby for the compresses so the mom doesn't have to hop up and down to go to the sink between breasts, one mom said she used a crockpot plugged in close by to to be able to adjust/interrupt heating to attain the comfortable temperature for the second side without danger of burning.


An additional suggestion comes to mind in light of my recent learning experience with a mom with Reynaud's who found even gentle RPS on the areola very painful, but had no pain while pumping!!! It might be helpful to have her observe closely for color changes that might suggest this as a cause. A recent article suggested that Reynaud's is sometimes a sequel to certain kinds of breast surgery, and considering she has had both breast surgery and an actual history of nipple damage as well, I think it would be important to observe closely to rule this in or out. Until this most recent new mother's (my granddaughter-in-law) feedback, I have always found that pain could be avoided while doing RPS, simply by lessening the degree of pressure and holding it for a longer time. But it did not seem to work in this recent situation which has all the symptoms of Reynaud's.

As a third "for instance" let me first be upfront about the fact that I believe in the presence of lactiferous sinuses, and I believe that they change during pregnancy and the early stages of the breastfeeding process, and involute after weaning, similar to the way the shape of the uterus is changed with both pregnancy and involution. I have seen numerous microscopic pictures of them in the histology literature. There is a thick layer of elastic tissue enclosing the outer wall of the adult female's lactiferous sinuses which is not present around those of children or men. * (Montagna W, Macpherson E, Some Neglected Aspects of the Anatomy of Human Breasts, Journ Inv Derm, July 1974, Vol 63;1: p. 10-16.) I believe that much early latch pain is not even in the nipple per se, but in the elastic tissues described above, when the sinuses are compressed when very full. (Imagine the sensation you get when you have a fairly full bladder, and the brakes are slammed on forcefully, causing your seatbelt to compress the very most distended part of the bladder wall!!!)


Similar to the elastic in our clothes that changes when repeatedly stretched, when this elastic tissue surrounding the  walls of the lactiferous sinuses is gently stretched by repeated suckling (or pumping), it seems to gradually cause the elastic tissue to loosen enough over the course of several weeks, so that compression will no longer cause pain. I think it would be worth a try to teach her to do gentle RPS (which presses on the anterior end, not the "belly" of the sinuses) for 2 minutes before latching in order to empty the sinuses temporarily by moving any milk back upward an inch or so into the deeper ducts before latching. 

Let us know if any of these suggestions work- or don't work- so we can benefit from your observations and conclusions.

K. Jean Cotterman RNC-E, IBCLC
WiC Volunteer LC    Dayton OH

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