Cindy, You wrote: <she still has one crack on each nipple, theses are different than any I have seen, one is horizontal and one is vertical, if she gently separates the crack you can see that deep in the crack at the base there is healed skin, but the crack above is still a crack and causing pain, we have changed positions frequently, breastfeeding is ok but not really enjoyable for this mom. > I wonder if this could partially be a developmental fissure, resulting from a different depth and distribution of squamous epithelial cells which normally line both the surface of the nipple and all the way down and inside the pores of the nipple. I wonder if this is the case especially on the side where the one "crack" is horizontal? I have seen some nipples which, to the naked eye, look somewhat bifurcated (as if partitioned in two, horizontally, by a crevice). I have seen others where, prenatally, if one pulled apart at the base of the nipple, the "button" spread open like a 4 petaled flower, displaying a bright red, raw appearing lining, even brighter than the mucosal lining of the mouth or eye. Pamela Morrison, from Zimbabwe, also found a mom with nipples that fit this description. (I do not, however, remember any appearance of normal skin at the center of these "flowers" on the particular nipples I took close-ups of. I will go back and look at the slides closely again.) From this, it makes me wonder if another developmental variation might just as easily cause a vertical bifurcation, and that such an appearing nipple, when separated, might also look raw. I have assumed in these cases that fetal downgrowth of the mammary pit did not proceed as far downward before proliferation of connective tissue beneath it began the process of nipple eversion. I have cautioned these few mothers that this is left over from the fetal development of their nipple, and that it is a perfectly normal condition for them, and not to let any HCP's freak out over apparent "cracks" in the nipple. But I have also cautioned them to be sure to allow the internal surface to dry before letting it close after it was spread open by the vacuum forces of nursing, as this type of surface would probably put her at higher risk of developing yeast there. It may be in need of further "APNO" treatment inside the crack, if infection of any kind is in fact present. But then again, if it is healthy tissue composed of normal cuboidal cells like the lining of the interior ducts, it may look frightening, but be a normal "crack" never noticed before nursing, that may not necessarily be the site of her pain. It would be interesting to have you (or her) use a sterile q-tip to touch or stroke just that red, raw appearing tissue and ask her to rate the sensation on a pain scale. It might well be very painful if infected or traumatized, but then again, both of you might be surprised not to find it so. There are other parts of the nipple-areolar complex that can produce severe pain on latch, even at 4 weeks. This can be assessed by using different techniques, and relieved with different interventions other than wound-healing tactics. It would also be interesting to observe whether the pain is confined, or much worse during the first 60-120+ seconds after latch, or if it slacks off and/or reemerges at some point during the feeding. Some curious part of me wishes I could be there to see and assess the situation in person. I would be interested to hear what you find if you look at the situation from this perspective. Jean ********************************* K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA ________________________________________________________________ YOU'RE PAYING TOO MUCH FOR THE INTERNET! Juno now offers FREE Internet Access! Try it today - there's no risk! For your FREE software, visit: http://dl.www.juno.com/get/tagj. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html