Greetings everyone
I have a problem with a client who has a recurrent blockage of a duct
at the nipple, and what appears to be an underlying galactocoele.
Baby is now 5 months, and this has been happening for at least 4
months. It also occured to a lesser extent with a previous baby, but
resolved after 2 months.
She has noted a small yellow 'scab' on her nipple which was painless
and can be either picked off after a shower, or sometimes clears
after feeding her baby. If the 'scab' doesn't clear, she develops a
cordlike swelling running from the nipple to the inferior breast
surface. The swelling is compressible and feels like a galactocoele
to me.
She was referred to a surgeon by another doctor. Surgeon decided to
drain the 'cyst' and drained milk (surprise, surprise!!!) He said the
problem was fixed, but of course the nipple problem has recurred, as
has the swelling.
Mother has been treated for bacterial and fungal infections, has used
moist warmth, frequent feedings, expressing etc with no result. The
spot on the nipple is yellow and about 2mm diameter. If I try to pop
it with a needle, there is no release of milk.
I'm a bit stumped about this. It doesn't seem to relate to the white
dot on the nipple which is skin growing over a duct, or thrush, or
anything I can think of. I wondered if an inflammed montgomery's
tubercle could occlude a duct by pressure, but can't find any
reference to that happening.
If anyone has any suggestions to offer, I would appreciate it, as
mother and myself are frustrated and out of ideas.

Fiona Coombes MBBS IBCLC               [log in to unmask]
Lactation Consultant, Family Physician
Perth Western Australia