Karen,
I'll take a stab at this.
First, I think it's important to realize that at the outset, you're
dealing with this mom's own interpretation of her breast. Such
interpretations are by definition, very subjective. Ergo, some objective
things may be being missed. I'm not certain that mammography will add
much, as one has to know how to interpret the shadows!
<Spontaneous, no specific relation to a feed>
My first thought is MER, and that she may be so fucused on the baby she
hadn't noticed it during feeds. In fact, oversupply with OALD may have
developed.
<area of breast, usually outer
upper, hardness firmness very tender, with the addition of a peanut-y
sized
lumps kindof ropey feelings of under the skin swellings.>
UOQ of the breast contains 50% of the glandular tissue. Sounds like
possible oversupply issues. The peanutty things = individual lobules in
the lobes. The ropey feelings = ducts, in the process of strongly
contracting in length and dilating in circumference during overactive
MER.
Fuctuations in the % of fat and connective tissue and glandular tissue
are normal and going on in some way almost constantly during a woman's
reproductive years.
< Her description
is that the area looks like and feels like cellulite when you squeeze
it.>
The cellulite feeling = looseness in the fatty tissue. (I wonder if she
has recently lost a fair amount of weight fairly rapidly???) Fat is
frequently used/replaced/redistributed in the normal process of "breast
remodeling" that goes on during various phases of a woman's reproductive
life within the skin envelope we know as the breast.
<For about 1/2 hour after this occurs, she will get shooting pains
throughout
the whole breast.>
Pain in ducts - overdilatation due to oversupply, OALD painful. Maybe
some beginning or at least temporarily plugged ducts.
<This happens 1-2 times a week, again no relation to fullness or
feeds/emptying. Spontaneously occurs, then gradually goes away.>
I bet there is a relationship, but she just doesn't recognize it. I do
not hear you saying it happens during feeds. Therefore, I deduce that
without relief at the nipple end, the upper ducts don't have as much
space to empty into, and that these are MER's that are painful because
the ducts stay relatively dilated to contain the milk that's not being
removed at the time it is happening.
<Has been on a two week course of Diflucon, doc rx'ed for the shooting
pain
symptoms. No change.>
Discussion this past week on referred nerve pain may have some
application if this has been going on for a while. Maybe nifedipine?
After a trial of Gonneke's plan for dealing with oversupply though. (Pump
both sides thoroughly. Let babe nurse "empty" breasts for the cream. Then
manage supply by nursing several feedings on one breast only, alternating
breasts every 4-6, or 6-8 hours or so etc.)
<A couple times has gotten these lumps circling the areola, looking like
a
bunch of mosquito bites but white, and below the surface. Nothing
pimpley-poppable looking.>
Lactiferous sinuses. Even they have myoepithelial cells in their walls,
and participate in MER. Again I suspect this is visible due to rapid
decrease in her fatty tissue from possible rapid weight loss.
<She says her skin does not seem to be orange-peely looking-- it looks
normal
between episodes.>
Orange-peely look comes from edema around hair follicles and pores. She
doesn't have edema. Just a lot of milk, OALD, and recent rapid weight
loss, I suspect.
I'd be interested to know if I'm on target.
Jean
***********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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