I looked in the archives and found some posts related to this subject,
but not specific for what I'm looking for.
 I've just had a referral for a mom of a 34 week premi who is now 1-1/2
weeks post delivery. By appearence, mother would qualify for a possible
visual dx of hypoplasia including minimal breast tissue and wide space
between breast. Breast are mainly at their fullest just behind the areola
region and only  rise about a golf ball size above the chest wall..
Anyway, mom has been expressing at least 2-3 oz Q2 hours but as we talked
she said she always has some discomfort with pumping due to the clumps in
her milk. When I asked to see her milk, it has very thick mucoidal milk
lumps- not just a few but in the 1 oz she pumped for me  right then,
removing the large 3-4 clumps subtracted almost 20cc. the remaining 10 cc
were normal breastmilk content in appearence. The lumps were so thick that
no matter how I tried, it never mixed or broke down and  will not pass
through a bottle nipple or feeding tube/ SNS. Baby does not  elicit any
letdown when attempting to nurse.Mom only lets down at this time with a
hospital pump.
 I saw on previous posts that this was sometimes seen post mastits or due
to lipase breakdown after freezing, but I've worked with many moms
expressing stringy clumps due to mastitis and have never seen this type of
large dense clumping before. I'm serious, the clumps emerge from the
nipple in this thick ooze and are about the thickness of almost a  pencil
and  a good 1-2 inches long when they fall into the collection chamber!
 No lumps felt in the breast, not signs of mastitis, no nipple trauma when
the ducts expell this... WOW- facinating but hard to feed the baby!
 I was thinking maybe suggesting some lecithin to see if this can thin the
lumps down enough for them to mix...... does anyone have any suggestions
or thought? I'm really stumped!!!!
 Thanks, Lisa Jones

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