Tina - you wrote of a mom due in 3 weeks who had breast surgery to have a
lump removed a while ago and has been advised that she will have to stop
breastfeeding because she will get mastitis.

Nonsense!  Suggest that mom ask the OB if she can have a "trial of
lactation".  Maybe she will teach him something!  Firstly, even if some of
the ducts have been severed, it is possible for them to re-canalize during
this pregnancy, and subsequently drain.  Secondly, even if the ducts which
were severed do *not* drain, the rest of the breast will be fine, and the
*other* breast will be functional (mom could even breastfeed with one
breast, if it comes to that).

The worst case scenario could be that the area of the breast behind the
incision does not drain.  As the milk comes in it will become lumpy,
overfull and engorged in *only* that duct.  Mom will need to do all that she
can to drain that duct (breastfeed baby often, chin pointing to the area,
and/or express and/or pump).  In spite of this, if it still will not drain,
then she should continue breastfeeding on this breast and she can use
cabbage leaves over only that area.  She needs to watch for inflammation,
which would be a symptom of mastitis.  If there is any inflammation she
needs to obtain a prescription for an antibiotic which is compatible with
breastfeeding and continue breastfeeding and treating the area with cabbage.
Ibuprofen (an anti-inflammatory and pain-killer) could be helpful. The
affected duct(s) will be hard for a few days and will then slowly involute,
and give no more trouble.  The rest of the breast will continue to function,
and she can continue breastfeeding. Reassure your client that this should
*not* be a problem.  The key to this is to ensure meticulous drainage (sorry
to go on about this, people!) of the *rest* of that breast, and of the other
intact breast.

Someone asked why it is that there is over-production of milk in the first
week or so after delivery.  I read somewhere that Nature doesn't know that
you didn't have triplets, but maybe it is to provide for just such an
eventuality (an injury to the breast(s)) and to absolutely ensure that the
food-source for the baby will be adequate.

Pamela Morrison IBCLC, Zimbabwe

             ***********************************************
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