Wise Ones:
Once again, I could sure use your assistance. I have a client (permission
to post) who developed an abscess 6 months after having her nipple pierced
in 1999. She saw a surgeon, in 2000, who made (what she described as) a
nearly 180 degree cut on her areola, running from 5 o'clock to 11 o'clock,
in order to remove the abscess. No additional problems until recent
delivery 4 days ago. She is terribly engorged, but only in the
corresponding quadrant of that breast. She reports that she began leaking
from the nipple piercings 5 months ago, so we know that some of the ducts
are intact. But she only has partial sensation in that nipple, and
describes a large, bulbous callous on the end of her nipple...like 'scar
tissue'.
I haven't seen this client in person yet, but we have an appointment set
for the morning. She told me that an RN at her OB's office told her not to
nurse from that breast. In light of the fact that some of her ducts are
obviously intact, I felt that was dangerous advice, and might throw her
into mastitis, as she already seems to have plugged ducts, but only in the
affected quadrant of that particular breast. I did refer her back to her OB
for an examination, as it occurred to me that she might be in danger of
developing another abscess in the same spot. The OB saw her immediately,
confirmed that ducts had been severed, and advised her to continue nursing
on that breast.(yeah!)
I thought she might benefit from packing that area of the breast in ice,
and I also told her to put cabbage inside of her bra, (but only in that
quadrant), when she wasn't nursing or using ice. My question is, how long
would you expect it to take for the alveoli to involute in the area where
the ducts are severed? I'd also be interested in hearing of anything
besides ice and cabbage to help her get through the transition period. I
was reluctant to suggest peppermints or sudafed, as I felt they would ding
her supply and as she is going to be supplying her baby w/what amounts to 1
and one-half breasts, I didn't even want to go there.
I know that the Hartmann research indicated that ducts are not always
radial, but in this case, the areas where the ducts are severed do seem to
correspond radially with the incision on the areola, and at least are
noticably visible.
Any thoughts or suggestions to help this woman? As always, thank you all
for your consideration and assistance. I continue to grow with this great
venue.
Niki Konchar, IBCLC
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